Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $25.70 / $44.67	Facility	26	$22.39	$25.70	$44.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $109.65 / $295.12	Professional		$67.61	$109.65	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $40.74 / $131.83	Professional	26	$26.92	$40.74	$131.83
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $50.12 / $263.03 / $724.44	Professional	50	$50.12	$263.03	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $69.18 / $128.82	Professional	TC	$46.77	$69.18	$128.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $81.28 / $125.89	Professional		$66.07	$81.28	$125.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $41.69 / $79.43	Professional	26	$25.70	$41.69	$79.43
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $100.00 / $128.82 / $204.17	Professional	50	$100.00	$128.82	$204.17
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $69.18 / $97.72	Professional	TC	$48.98	$69.18	$97.72
BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $75.86 / $102.33	Professional		$28.18	$75.86	$102.33
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $128.82 / $186.21	Professional		$89.13	$128.82	$186.21
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $54.95 / $54.95	Professional	26	$33.11	$54.95	$54.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	26	$8.51	$39.81	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $114.82 / $208.93	Professional		$81.28	$114.82	$208.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $39.81 / $72.44	Professional	26	$28.84	$39.81	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $75.86 / $144.54	Professional	TC	$52.48	$75.86	$144.54
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $218.78 / $218.78	Facility	26	$218.78	$218.78	$218.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $660.69 / $851.14	Professional		$114.82	$660.69	$851.14
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $281.84 / $281.84	Professional	26	$218.78	$281.84	$281.84
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $575.44 / $575.44	Professional	TC	$446.68	$575.44	$575.44
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $28.18 / $42.66	Facility	26	$22.39	$28.18	$42.66
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $123.03 / $251.19	Professional		$77.62	$123.03	$251.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $43.65 / $107.15	Professional	26	$26.92	$43.65	$107.15
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $53.70 / $281.84 / $741.31	Professional	50	$53.70	$281.84	$741.31
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $77.62 / $147.91	Professional	TC	$51.29	$77.62	$147.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $33.11 / $87.10	Professional		$28.84	$33.11	$87.10
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $93.33 / $181.97	Professional		$35.48	$93.33	$181.97
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	26	$8.51	$39.81	$56.23
Providence Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $112.20 / $223.87	Professional		$83.18	$112.20	$223.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $37.15 / $67.61	Professional	26	$28.84	$37.15	$67.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $70.79 / $128.82	Professional	TC	$52.48	$70.79	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $114.82 / $173.78	Professional		$87.10	$114.82	$173.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $38.90 / $58.88	Professional	26	$29.51	$38.90	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $75.86 / $114.82	Professional	TC	$57.54	$75.86	$114.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $100.00 / $120.23	Professional		$95.50	$100.00	$120.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $34.67 / $40.74	Professional	26	$33.11	$34.67	$40.74
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $66.07 / $79.43	Professional	TC	$63.10	$66.07	$79.43