Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $10.00 / $11.75	Facility	26	$9.12	$10.00	$11.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $69.18 / $165.96	Professional		$46.77	$69.18	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.98 / $54.95	Professional	26	$10.96	$16.98	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $45.71 / $93.33	Professional	TC	$32.36	$45.71	$93.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $51.29 / $95.50	Professional		$40.74	$51.29	$95.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $13.80 / $24.55	Professional	26	$10.72	$13.80	$24.55
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $42.66 / $64.57	Professional	TC	$35.48	$42.66	$64.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $48.98 / $63.10	Professional		$11.22	$48.98	$63.10
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $72.44 / $109.65	Professional		$51.29	$72.44	$109.65
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $37.15 / $37.15	Professional	26	$13.49	$37.15	$37.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.55 / $16.60 / $23.44	Facility	26	$3.55	$16.60	$23.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $69.18 / $128.82	Professional		$48.98	$69.18	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $19.05 / $38.02	Professional	26	$12.30	$19.05	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $51.29 / $95.50	Professional	TC	$34.67	$51.29	$95.50
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	26	$125.89	$125.89	$125.89
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $524.81 / $524.81	Professional		$398.11	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $218.78 / $218.78	Professional	26	$138.04	$218.78	$218.78
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $407.38 / $407.38	Professional	TC	$354.81	$407.38	$407.38
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $10.72 / $11.75	Facility	26	$8.91	$10.72	$11.75
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $75.86 / $151.36	Professional		$46.77	$75.86	$151.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.78 / $40.74	Professional	26	$10.96	$17.78	$40.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $53.70 / $104.71	Professional	TC	$34.67	$53.70	$104.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.02 / $33.11 / $50.12	Professional		$12.02	$33.11	$50.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $60.26 / $128.82	Professional		$15.14	$60.26	$128.82
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.55 / $16.60 / $23.44	Facility	26	$3.55	$16.60	$23.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $69.18 / $138.04	Professional		$48.98	$69.18	$138.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $17.78 / $33.88	Professional	26	$12.30	$17.78	$33.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $46.77 / $85.11	Professional	TC	$34.67	$46.77	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $63.10 / $102.33	Professional		$51.29	$63.10	$102.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $17.38 / $28.18	Professional	26	$13.80	$17.38	$28.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $46.77 / $72.44	Professional	TC	$35.48	$46.77	$72.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $63.10 / $74.13	Professional		$60.26	$63.10	$74.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $14.79 / $17.38	Professional	26	$14.13	$14.79	$17.38
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $47.86 / $57.54	Professional	TC	$45.71	$47.86	$57.54