Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.22 / $28.89 / $45.12	Facility	26	$22.22	$28.89	$45.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.68 / $98.70 / $194.00	Professional		$67.68	$98.70	$194.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.92 / $32.67 / $57.73	Professional	26	$23.92	$32.67	$57.73
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $119.27 / $250.38 / $747.78	Professional	50	$119.27	$250.38	$747.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.47 / $61.74 / $109.28	Professional	TC	$45.47	$61.74	$109.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.37 / $79.65 / $100.51	Professional		$66.37	$79.65	$100.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.78 / $36.38 / $79.38	Professional	26	$25.78	$36.38	$79.38
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $99.56 / $120.23 / $157.72	Professional	50	$99.56	$120.23	$157.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.22 / $74.09 / $74.09	Professional	TC	$43.22	$74.09	$74.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.37 / $72.78 / $102.63	Professional		$28.37	$72.78	$102.63
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $90.08 / $132.75 / $171.15	Professional		$90.08	$132.75	$171.15
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $32.74 / $34.54 / $67.31	Professional	26	$32.74	$34.54	$67.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.91 / $109.80 / $202.71	Professional		$81.91	$109.80	$202.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.11 / $37.64 / $70.97	Professional	26	$28.11	$37.64	$70.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.87 / $71.95 / $132.34	Professional	TC	$52.87	$71.95	$132.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $82.13 / $170.67 / $170.67	Facility	26	$82.13	$170.67	$170.67
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $667.61 / $667.61 / $853.65	Professional		$667.61	$667.61	$853.65
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $219.03 / $219.03 / $281.02	Professional	26	$219.03	$219.03	$281.02
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $448.58 / $448.58 / $572.54	Professional	TC	$448.58	$448.58	$572.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $58.18 / $133.62 / $315.00	Professional		$58.18	$133.62	$315.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.46 / $53.82 / $134.56	Professional	26	$39.46	$53.82	$134.56
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $86.55 / $223.23 / $415.65	Professional	50	$86.55	$223.23	$415.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.64 / $98.01 / $261.36	Professional	TC	$76.64	$98.01	$261.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.36 / $72.34 / $151.66	Professional		$34.36	$72.34	$151.66
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $83.39 / $113.87 / $237.01	Professional		$83.39	$113.87	$237.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.52 / $36.25 / $66.15	Professional	26	$28.52	$36.25	$66.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $53.01 / $68.98 / $124.79	Professional	TC	$53.01	$68.98	$124.79
United Facility/Professional Professional Modifier Low / Median / High Price $87.08 / $114.29 / $171.20	Professional		$87.08	$114.29	$171.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.74 / $39.03 / $59.91	Professional	26	$29.74	$39.03	$59.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.74 / $75.19 / $112.81	Professional	TC	$54.74	$75.19	$112.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $84.48 / $94.82 / $134.41	Professional		$84.48	$94.82	$134.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.71 / $33.07 / $46.30	Professional	26	$28.71	$33.07	$46.30
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $55.77 / $61.74 / $88.78	Professional	TC	$55.77	$61.74	$88.78