Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.09 / $29.89 / $46.04	Facility	26	$23.09	$29.89	$46.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.55 / $104.10 / $446.00	Professional		$69.55	$104.10	$446.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.21 / $35.72 / $129.60	Professional	26	$25.21	$35.72	$129.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.13 / $56.61 / $118.52	Professional	TC	$39.13	$56.61	$118.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.08 / $89.50 / $144.52	Professional		$68.08	$89.50	$144.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.46 / $34.50 / $65.67	Professional	26	$26.46	$34.50	$65.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.10 / $53.48 / $92.35	Professional	TC	$46.10	$53.48	$92.35
BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.19 / $66.16 / $94.55	Professional		$29.19	$66.16	$94.55
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $76.20 / $115.25 / $167.00	Professional		$76.20	$115.25	$167.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $33.39 / $36.21 / $63.34	Professional	26	$33.39	$36.21	$63.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.86 / $40.86 / $40.86	Facility	26	$40.86	$40.86	$40.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.28 / $99.03 / $187.66	Professional		$74.28	$99.03	$187.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.06 / $38.32 / $70.31	Professional	26	$29.06	$38.32	$70.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.77 / $60.59 / $115.42	Professional	TC	$44.77	$60.59	$115.42
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $84.15 / $174.61 / $174.61	Facility	26	$84.15	$174.61	$174.61
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $600.27 / $600.27 / $764.25	Professional		$600.27	$600.27	$764.25
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $233.19 / $240.89 / $285.00	Professional	26	$233.19	$240.89	$285.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $372.64 / $372.64 / $479.25	Professional	TC	$372.64	$372.64	$479.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $60.14 / $133.43 / $280.80	Professional		$60.14	$133.43	$280.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.22 / $54.86 / $137.16	Professional	26	$40.22	$54.86	$137.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.13 / $82.01 / $218.68	Professional	TC	$64.13	$82.01	$218.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.04 / $62.85 / $147.19	Professional		$33.04	$62.85	$147.19
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $40.86 / $40.86 / $40.86	Facility	26	$40.86	$40.86	$40.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $75.47 / $102.98 / $206.80	Professional		$75.47	$102.98	$206.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.35 / $36.64 / $68.02	Professional	26	$29.35	$36.64	$68.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.77 / $59.09 / $113.07	Professional	TC	$44.77	$59.09	$113.07
United Facility/Professional Professional Modifier Low / Median / High Price $78.89 / $103.76 / $155.90	Professional		$78.89	$103.76	$155.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $38.77 / $63.77	Professional	26	$30.60	$38.77	$63.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.82 / $62.78 / $97.34	Professional	TC	$49.82	$62.78	$97.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $75.92 / $85.38 / $120.83	Professional		$75.92	$85.38	$120.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.27 / $33.72 / $47.22	Professional	26	$29.27	$33.72	$47.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $46.66 / $51.66 / $74.26	Professional	TC	$46.66	$51.66	$74.26