Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $23.99 / $26.92	Facility	26	$20.89	$23.99	$26.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $109.65 / $239.88	Professional		$83.18	$109.65	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $37.15 / $91.20	Professional	26	$25.70	$37.15	$91.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $74.13 / $120.23	Professional	TC	$58.88	$74.13	$120.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $208.93	Professional		$104.71	$144.54	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $33.11 / $57.54	Professional	26	$25.12	$33.11	$57.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $85.11 / $114.82	Professional		$25.70	$85.11	$114.82
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $125.89 / $169.82	Professional		$100.00	$125.89	$169.82
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $31.62 / $33.88	Professional	26	$30.90	$31.62	$33.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $38.02 / $53.70	Facility	26	$8.13	$38.02	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $120.23 / $218.78	Professional		$85.11	$120.23	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $38.90 / $72.44	Professional	26	$27.54	$38.90	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $83.18 / $158.49	Professional	TC	$58.88	$83.18	$158.49
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $912.01 / $912.01	Professional		$724.44	$912.01	$912.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $269.15 / $269.15	Professional	26	$208.93	$269.15	$269.15
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $630.96 / $630.96	Professional	TC	$524.81	$630.96	$630.96
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $21.88 / $26.92	Facility	26	$20.89	$21.88	$26.92
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $123.03 / $263.03	Professional		$85.11	$123.03	$263.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $39.81 / $85.11	Professional	26	$26.92	$39.81	$85.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $81.28 / $162.18	Professional	TC	$58.88	$81.28	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $33.11 / $93.33	Professional		$27.54	$33.11	$93.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $100.00 / $234.42	Professional		$33.11	$100.00	$234.42
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $38.02 / $53.70	Facility	26	$8.13	$38.02	$53.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $120.23 / $245.47	Professional		$85.11	$120.23	$245.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $36.31 / $63.10	Professional	26	$27.54	$36.31	$63.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $77.62 / $138.04	Professional	TC	$56.23	$77.62	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $109.65 / $177.83	Professional		$91.20	$109.65	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $34.67 / $57.54	Professional	26	$28.84	$34.67	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $74.13 / $120.23	Professional	TC	$61.66	$74.13	$120.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $104.71 / $125.89	Professional		$100.00	$104.71	$125.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $32.36 / $38.90	Professional	26	$31.62	$32.36	$38.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $72.44 / $87.10	Professional	TC	$69.18	$72.44	$87.10