Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.98 / $16.84 / $28.18	Facility	26	$12.98	$16.84	$28.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.61 / $83.50 / $160.88	Professional		$64.61	$83.50	$160.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.78 / $18.69 / $38.11	Professional	26	$13.78	$18.69	$38.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.63 / $65.13 / $109.57	Professional	TC	$51.63	$65.13	$109.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.79 / $77.09 / $190.56	Professional		$75.79	$77.09	$190.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.25 / $19.05 / $31.70	Professional	26	$15.25	$19.05	$31.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $63.21 / $63.21 / $63.21	Professional	TC	$63.21	$63.21	$63.21
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.48 / $69.56 / $106.74	Professional		$16.48	$69.56	$106.74
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $81.80 / $130.11 / $153.38	Professional		$81.80	$130.11	$153.38
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $18.88 / $18.88 / $20.12	Professional	26	$18.88	$18.88	$20.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.18 / $92.36 / $176.71	Professional		$67.18	$92.36	$176.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $22.55 / $41.18	Professional	26	$16.16	$22.55	$41.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.96 / $71.83 / $138.77	Professional	TC	$50.96	$71.83	$138.77
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $98.94 / $98.94	Facility	26	$50.00	$98.94	$98.94
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $637.19 / $637.19 / $829.20	Professional		$637.19	$637.19	$829.20
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $127.82 / $127.82 / $162.08	Professional	26	$127.82	$127.82	$162.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $509.36 / $509.36 / $667.13	Professional	TC	$509.36	$509.36	$667.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $119.28 / $157.44 / $381.68	Professional		$119.28	$157.44	$381.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.23 / $32.03 / $77.64	Professional	26	$25.23	$32.03	$77.64
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $98.81 / $125.42 / $304.04	Professional	TC	$98.81	$125.42	$304.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $21.57 / $87.31 / $161.72	Professional		$21.57	$87.31	$161.72
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.18 / $108.06 / $238.40	Professional		$67.18	$108.06	$238.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.29 / $21.80 / $39.61	Professional	26	$16.29	$21.80	$39.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.67 / $71.09 / $136.21	Professional	TC	$49.67	$71.09	$136.21
United Facility/Professional Professional Modifier Low / Median / High Price $70.91 / $89.82 / $149.82	Professional		$70.91	$89.82	$149.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.09 / $21.28 / $35.13	Professional	26	$17.09	$21.28	$35.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.65 / $69.59 / $112.76	Professional	TC	$54.65	$69.59	$112.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $81.44 / $90.89 / $129.56	Professional		$81.44	$90.89	$129.56
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.57 / $19.05 / $26.34	Professional	26	$16.57	$19.05	$26.34
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $64.87 / $71.83 / $103.22	Professional	TC	$64.87	$71.83	$103.22