Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $10.47 / $21.88	Facility	26	$9.55	$10.47	$21.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $42.66 / $104.71	Professional		$29.51	$42.66	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.85 / $43.65	Professional	26	$10.96	$15.85	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $53.70	Professional	TC	$16.98	$25.12	$53.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $40.74 / $48.98	Professional		$33.88	$40.74	$48.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $3.47 / $14.79 / $29.51	Professional	26	$3.47	$14.79	$29.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $20.89 / $20.89	Professional	TC	$20.89	$20.89	$20.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $32.36 / $45.71	Professional		$12.88	$32.36	$45.71
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $48.98 / $61.66	Professional		$36.31	$48.98	$61.66
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $14.13 / $15.14	Professional	26	$14.13	$14.13	$15.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.72 / $17.38 / $24.55	Facility	26	$3.72	$17.38	$24.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $52.48 / $112.20	Professional		$32.36	$52.48	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $17.78 / $35.48	Professional	26	$12.59	$17.78	$35.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $35.48 / $72.44	Professional	TC	$19.50	$35.48	$72.44
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $346.74 / $389.05	Professional		$346.74	$346.74	$389.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $123.03 / $123.03	Professional	26	$102.33	$123.03	$123.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $257.04 / $302.00	Professional	TC	$257.04	$257.04	$302.00
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $10.23 / $19.50	Facility	26	$9.55	$10.23	$19.50
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $52.48 / $109.65	Professional		$30.20	$52.48	$109.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $18.62 / $41.69	Professional	26	$11.22	$18.62	$41.69
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $33.11 / $64.57	Professional	TC	$18.20	$33.11	$64.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.59 / $32.36 / $33.11	Professional		$12.59	$32.36	$33.11
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $43.65 / $95.50	Professional		$15.85	$43.65	$95.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.72 / $17.38 / $24.55	Facility	26	$3.72	$17.38	$24.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $53.70 / $104.71	Professional		$32.36	$53.70	$104.71
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $16.22 / $29.51	Professional	26	$12.59	$16.22	$29.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $31.62 / $63.10	Professional	TC	$19.50	$31.62	$63.10
United Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $47.86 / $83.18	Professional		$34.67	$47.86	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.49 / $26.30	Professional	26	$12.88	$15.49	$26.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.84 / $58.88	Professional	TC	$20.42	$28.84	$58.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $41.69 / $50.12	Professional		$39.81	$41.69	$50.12
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $15.49 / $18.20	Professional	26	$14.79	$15.49	$18.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $26.92 / $31.62	Professional	TC	$25.12	$26.92	$31.62