Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $43.65 / $64.57	Facility	26	$40.74	$43.65	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $128.82 / $537.03	Professional		$85.11	$128.82	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $52.48 / $208.93	Professional	26	$41.69	$52.48	$208.93
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $177.83 / $281.84 / $575.44	Professional	50	$177.83	$281.84	$575.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $52.48 / $79.43	Professional	TC	$42.66	$52.48	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $97.72 / $131.83	Professional		$83.18	$97.72	$131.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $45.71 / $67.61	Professional	26	$39.81	$45.71	$67.61
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $138.04 / $144.54 / $190.55	Professional	50	$138.04	$144.54	$190.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $69.18 / $114.82	Professional		$36.31	$69.18	$114.82
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $109.65 / $158.49	Professional		$91.20	$109.65	$158.49
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $89.13 / $89.13	Professional	26	$44.67	$89.13	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $123.03 / $190.55	Professional		$89.13	$123.03	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $57.54 / $97.72	Professional	26	$43.65	$57.54	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $61.66 / $102.33	Professional	TC	$44.67	$61.66	$102.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $281.84 / $281.84 / $281.84	Facility	26	$281.84	$281.84	$281.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $645.65 / $776.25	Professional		$95.50	$645.65	$776.25
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $354.81 / $354.81	Professional	26	$281.84	$354.81	$354.81
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $416.87 / $416.87	Professional	TC	$354.81	$416.87	$416.87
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $40.74 / $64.57	Facility	26	$33.88	$40.74	$64.57
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $112.20 / $316.23	Professional		$85.11	$112.20	$316.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $50.12 / $102.33	Professional	26	$40.74	$50.12	$102.33
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $173.78 / $316.23 / $562.34	Professional	50	$173.78	$316.23	$562.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $54.95 / $97.72	Professional	TC	$43.65	$54.95	$97.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $36.31 / $74.13	Professional		$32.36	$36.31	$74.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $104.71 / $218.78	Professional		$50.12	$104.71	$218.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $125.89 / $213.80	Professional		$89.13	$125.89	$213.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $57.54 / $95.50	Professional	26	$43.65	$57.54	$95.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $61.66 / $95.50	Professional	TC	$44.67	$61.66	$95.50
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $102.33 / $165.96	Professional		$77.62	$102.33	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $52.48 / $81.28	Professional	26	$38.02	$52.48	$81.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $52.48 / $81.28	Professional	TC	$38.02	$52.48	$81.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $100.00 / $120.23	Professional		$70.79	$100.00	$120.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $45.71 / $54.95	Professional	26	$33.88	$45.71	$54.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $53.70 / $64.57	Professional	TC	$37.15	$53.70	$64.57