Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $79.43 / $128.82	Facility	26	$53.70	$79.43	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $1,023.29	Professional		$208.93	$295.12	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $107.15 / $363.08	Professional	26	$72.44	$107.15	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $169.82 / $302.00	Professional	TC	$123.03	$169.82	$302.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $234.42 / $275.42	Professional		$194.98	$234.42	$275.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $93.33 / $114.82	Professional	26	$72.44	$93.33	$114.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $144.54 / $288.40	Professional	TC	$144.54	$144.54	$288.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $165.96 / $309.03	Professional		$66.07	$165.96	$309.03
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $269.15 / $338.84	Professional		$234.42	$269.15	$338.84
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $114.82 / $114.82	Professional	26	$79.43	$114.82	$114.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $316.23 / $537.03	Professional		$229.09	$316.23	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $114.82 / $194.98	Professional	26	$83.18	$114.82	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $199.53 / $346.74	Professional	TC	$151.36	$199.53	$346.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $524.81 / $524.81 / $524.81	Facility	26	$524.81	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Professional		$2,398.83	$2,398.83	$2,398.83
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $524.81 / $645.65 / $645.65	Professional	26	$524.81	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $977.24 / $1,258.93 / $1,258.93	Professional	TC	$977.24	$1,258.93	$1,258.93
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $67.61 / $81.28	Facility	26	$52.48	$67.61	$81.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $309.03 / $691.83	Professional		$204.17	$309.03	$691.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $109.65 / $229.09	Professional	26	$72.44	$109.65	$229.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $186.21 / $331.13	Professional	TC	$123.03	$186.21	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $194.98	Professional		$32.36	$33.11	$194.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $295.12 / $562.34	Professional		$91.20	$295.12	$562.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $323.59 / $524.81	Professional		$223.87	$323.59	$524.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $114.82 / $173.78	Professional	26	$83.18	$114.82	$173.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $199.53 / $316.23	Professional	TC	$151.36	$199.53	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $269.15 / $446.68	Professional		$204.17	$269.15	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $95.50 / $165.96	Professional	26	$70.79	$95.50	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $169.82 / $281.84	Professional	TC	$128.82	$169.82	$281.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $234.42 / $281.84	Professional		$223.87	$234.42	$281.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $81.28 / $100.00	Professional	26	$79.43	$81.28	$100.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $151.36 / $181.97	Professional	TC	$144.54	$151.36	$181.97