Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.80 / $25.64 / $39.93	Facility	26	$19.80	$25.64	$39.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.76 / $96.63 / $380.00	Professional		$60.76	$96.63	$380.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.49 / $35.92 / $125.14	Professional	26	$22.49	$35.92	$125.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.57 / $51.52 / $114.64	Professional	TC	$34.57	$51.52	$114.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.49 / $82.63 / $133.22	Professional		$55.49	$82.63	$133.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.09 / $29.27 / $57.07	Professional	26	$23.09	$29.27	$57.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $32.09 / $44.29 / $81.98	Professional	TC	$32.09	$44.29	$81.98
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.37 / $57.98 / $83.03	Professional		$25.37	$57.98	$83.03
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $105.17 / $179.46	Professional		$67.61	$105.17	$179.46
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $28.97 / $31.49 / $61.40	Professional	26	$28.97	$31.49	$61.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $35.11 / $35.11	Facility	26	$35.11	$35.11	$35.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.81 / $89.18 / $166.47	Professional		$64.81	$89.18	$166.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.16 / $33.11 / $61.46	Professional	26	$25.16	$33.11	$61.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.57 / $55.52 / $105.88	Professional	TC	$39.57	$55.52	$105.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.90 / $151.29 / $151.29	Facility	26	$85.90	$151.29	$151.29
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $524.64 / $524.64 / $673.35	Professional		$524.64	$524.64	$673.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $195.35 / $195.35 / $247.88	Professional	26	$195.35	$195.35	$247.88
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $329.23 / $329.23 / $425.48	Professional	TC	$329.23	$329.23	$425.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $44.18 / $111.00 / $187.09	Professional		$44.18	$111.00	$187.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.20 / $47.62 / $80.06	Professional	26	$37.20	$47.62	$80.06
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.65 / $77.63 / $117.42	Professional	TC	$60.65	$77.63	$117.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.56 / $55.38 / $129.79	Professional		$28.56	$55.38	$129.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $35.11 / $35.11	Facility	26	$35.11	$35.11	$35.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $65.50 / $90.45 / $187.87	Professional		$65.50	$90.45	$187.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.21 / $31.76 / $58.28	Professional	26	$25.21	$31.76	$58.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.57 / $52.74 / $102.37	Professional	TC	$39.57	$52.74	$102.37
United Facility/Professional Professional Modifier Low / Median / High Price $69.95 / $90.06 / $138.82	Professional		$69.95	$90.06	$138.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.35 / $33.77 / $52.15	Professional	26	$26.35	$33.77	$52.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.02 / $55.76 / $83.52	Professional	TC	$44.02	$55.76	$83.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.81 / $75.12 / $106.30	Professional		$66.81	$75.12	$106.30
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.40 / $29.27 / $40.98	Professional	26	$25.40	$29.27	$40.98
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $41.41 / $45.85 / $65.91	Professional	TC	$41.41	$45.85	$65.91