Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.56 / $12.37 / $19.30	Facility	26	$9.56	$12.37	$19.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.92 / $55.73 / $126.11	Professional		$43.92	$55.73	$126.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.87 / $14.56 / $35.18	Professional	26	$10.87	$14.56	$35.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.66 / $39.95 / $76.26	Professional	TC	$31.66	$39.95	$76.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.70 / $48.68 / $79.84	Professional		$28.70	$48.68	$79.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.39 / $14.36 / $27.88	Professional	26	$11.39	$14.36	$27.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $55.54 / $55.54 / $55.54	Professional	TC	$55.54	$55.54	$55.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.28 / $43.41 / $67.03	Professional		$12.28	$43.41	$67.03
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $54.07 / $66.00 / $102.17	Professional		$54.07	$66.00	$102.17
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $14.16 / $14.16 / $15.07	Professional	26	$14.16	$14.16	$15.07
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 $44.72 / $62.62 / $114.00	Professional		$44.72	$62.62	$114.00
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 $32.72 / $45.88 / $83.84	Professional	TC	$32.72	$45.88	$83.84
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 $395.03 / $395.03 / $522.08	Professional		$395.03	$395.03	$522.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.99 / $93.99 / $122.10	Professional	26	$93.99	$93.99	$122.10
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $301.02 / $301.02 / $400.05	Professional	TC	$301.02	$301.02	$400.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.56 / $99.26 / $162.00	Professional		$70.56	$99.26	$162.00
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 $59.29 / $75.26 / $182.44	Professional	TC	$59.29	$75.26	$182.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $16.14 / $54.19 / $106.49	Professional		$16.14	$54.19	$106.49
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 $45.71 / $70.88 / $148.80	Professional		$45.71	$70.88	$148.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.73 / $16.98 / $30.53	Professional	26	$12.73	$16.98	$30.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.60 / $45.49 / $82.59	Professional	TC	$32.60	$45.49	$82.59
United Facility/Professional Professional Modifier Low / Median / High Price $47.93 / $58.83 / $97.16	Professional		$47.93	$58.83	$97.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.23 / $26.37	Professional	26	$13.18	$16.23	$26.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.94 / $42.83 / $66.67	Professional	TC	$34.94	$42.83	$66.67
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $51.34 / $57.40 / $81.68	Professional		$51.34	$57.40	$81.68
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 $38.93 / $43.10 / $61.95	Professional	TC	$38.93	$43.10	$61.95