Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.34 / $12.09 / $19.09	Facility	26	$9.34	$12.09	$19.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.33 / $63.39 / $170.68	Professional		$42.33	$63.39	$170.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $14.55 / $30.89	Professional	26	$9.94	$14.55	$30.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.16 / $44.43 / $81.17	Professional	TC	$31.16	$44.43	$81.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.41 / $48.25 / $78.97	Professional		$45.41	$48.25	$78.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.18 / $15.38 / $28.66	Professional	26	$11.18	$15.38	$28.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $34.22 / $34.22 / $57.74	Professional	TC	$34.22	$34.22	$57.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.08 / $44.24 / $63.53	Professional		$12.08	$44.24	$63.53
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $59.61 / $85.16 / $113.54	Professional		$59.61	$85.16	$113.54
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $13.84 / $14.67 / $22.29	Professional	26	$13.84	$14.67	$22.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.25 / $70.69 / $124.76	Professional		$48.25	$70.69	$124.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.96 / $18.34 / $34.52	Professional	26	$11.96	$18.34	$34.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.94 / $51.52 / $91.13	Professional	TC	$35.94	$51.52	$91.13
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.08 / $126.00 / $126.00	Facility	26	$49.08	$126.00	$126.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $399.42 / $399.42 / $516.67	Professional		$399.42	$399.42	$516.67
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $151.90 / $151.90 / $151.90	Professional	26	$151.90	$151.90	$151.90
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $307.58 / $307.58 / $397.20	Professional	TC	$307.58	$307.58	$397.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.77 / $98.21 / $140.87	Professional		$56.77	$98.21	$140.87
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.50 / $23.48 / $56.92	Professional	26	$18.50	$23.48	$56.92
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $74.73 / $181.16	Professional	TC	$58.88	$74.73	$181.16
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.80 / $54.27 / $101.40	Professional		$15.80	$54.27	$101.40
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.17 / $78.78 / $161.97	Professional		$51.17	$78.78	$161.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.21 / $17.67 / $32.42	Professional	26	$12.21	$17.67	$32.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.94 / $50.74 / $89.05	Professional	TC	$35.94	$50.74	$89.05
United Facility/Professional Professional Modifier Low / Median / High Price $51.23 / $64.02 / $101.09	Professional		$51.23	$64.02	$101.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.71 / $16.17 / $26.38	Professional	26	$12.71	$16.17	$26.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.04 / $47.82 / $73.15	Professional	TC	$38.04	$47.82	$73.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.80 / $56.77 / $80.80	Professional		$50.80	$56.77	$80.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.14 / $13.98 / $19.29	Professional	26	$12.14	$13.98	$19.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $38.65 / $42.79 / $61.51	Professional	TC	$38.65	$42.79	$61.51