Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $15.85 / $29.51	Facility	26	$12.88	$15.85	$29.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $95.50 / $204.17	Professional		$67.61	$95.50	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $21.88 / $52.48	Professional	26	$15.14	$21.88	$52.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $69.18 / $138.04	Professional	TC	$51.29	$69.18	$138.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $79.43 / $117.49	Professional		$52.48	$79.43	$117.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $15.85 / $32.36	Professional	26	$15.14	$15.85	$32.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $15.49 / $75.86 / $97.72	Professional		$15.49	$75.86	$97.72
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $147.91 / $177.83	Professional		$91.20	$147.91	$177.83
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.05 / $19.95	Professional	26	$19.05	$19.05	$19.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.90 / $22.91 / $32.36	Facility	26	$4.90	$22.91	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $97.72 / $190.55	Professional		$66.07	$97.72	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $22.91 / $44.67	Professional	26	$16.22	$22.91	$44.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $75.86 / $154.88	Professional	TC	$50.12	$75.86	$154.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $831.76 / $831.76	Professional		$630.96	$831.76	$831.76
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $162.18 / $162.18	Professional	26	$128.82	$162.18	$162.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $660.69 / $660.69	Professional	TC	$512.86	$660.69	$660.69
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $15.85 / $29.51	Facility	26	$12.88	$15.85	$29.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $104.71 / $208.93	Professional		$67.61	$104.71	$208.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $23.44 / $50.12	Professional	26	$15.14	$23.44	$50.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $79.43 / $162.18	Professional	TC	$51.29	$79.43	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $33.11 / $83.18	Professional		$16.60	$33.11	$83.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $87.10 / $181.97	Professional		$20.42	$87.10	$181.97
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $4.90 / $22.91 / $32.36	Facility	26	$4.90	$22.91	$32.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $97.72 / $213.80	Professional		$66.07	$97.72	$213.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.88 / $38.02	Professional	26	$16.22	$21.88	$38.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $70.79 / $131.83	Professional	TC	$48.98	$70.79	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $87.10 / $144.54	Professional		$72.44	$87.10	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $20.89 / $33.88	Professional	26	$16.98	$20.89	$33.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $67.61 / $109.65	Professional	TC	$54.95	$67.61	$109.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $97.72 / $117.49	Professional		$93.33	$97.72	$117.49
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.95 / $23.99	Professional	26	$19.05	$19.95	$23.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $79.43 / $93.33	Professional	TC	$74.13	$79.43	$93.33