Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.68 / $12.61 / $20.02	Facility	26	$9.68	$12.61	$20.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.38 / $65.04 / $159.00	Professional		$48.38	$65.04	$159.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.57 / $15.01 / $41.75	Professional	26	$10.57	$15.01	$41.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.22 / $46.38 / $89.81	Professional	TC	$36.22	$46.38	$89.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.53 / $58.62 / $116.82	Professional		$45.53	$58.62	$116.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.44 / $14.94 / $26.33	Professional	26	$11.44	$14.94	$26.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $40.59 / $40.59 / $50.74	Professional	TC	$40.59	$40.59	$50.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.36 / $49.25 / $72.01	Professional		$12.36	$49.25	$72.01
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $63.72 / $97.56 / $126.83	Professional		$63.72	$97.56	$126.83
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $14.16 / $14.16 / $15.41	Professional	26	$14.16	$14.16	$15.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.46 / $70.34 / $125.96	Professional		$50.46	$70.34	$125.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.15 / $17.60 / $31.38	Professional	26	$12.15	$17.60	$31.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.90 / $52.98 / $98.60	Professional	TC	$37.90	$52.98	$98.60
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $73.77 / $73.77	Facility	26	$50.00	$73.77	$73.77
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $453.03 / $453.03 / $592.79	Professional		$453.03	$453.03	$592.79
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.54 / $95.54 / $122.10	Professional	26	$95.54	$95.54	$122.10
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $357.49 / $357.49 / $470.78	Professional	TC	$357.49	$357.49	$470.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $45.30 / $112.61 / $184.50	Professional		$45.30	$112.61	$184.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.93 / $24.02 / $58.24	Professional	26	$18.93	$24.02	$58.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.81 / $88.61 / $214.80	Professional	TC	$69.81	$88.61	$214.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $16.47 / $64.34 / $116.94	Professional		$16.47	$64.34	$116.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.62 / $79.30 / $169.34	Professional		$50.62	$79.30	$169.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.73 / $16.98 / $30.97	Professional	26	$12.73	$16.98	$30.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.28 / $52.12 / $98.09	Professional	TC	$37.28	$52.12	$98.09
United Facility/Professional Professional Modifier Low / Median / High Price $54.08 / $66.31 / $107.71	Professional		$54.08	$66.31	$107.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.28 / $16.55 / $26.68	Professional	26	$13.28	$16.55	$26.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.52 / $49.37 / $77.95	Professional	TC	$39.52	$49.37	$77.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $58.25 / $65.04 / $92.66	Professional		$58.25	$65.04	$92.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.43 / $14.30 / $19.72	Professional	26	$12.43	$14.30	$19.72
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $45.83 / $50.74 / $72.94	Professional	TC	$45.83	$50.74	$72.94