Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.12 / $27.35 / $42.56	Facility	26	$21.12	$27.35	$42.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.80 / $135.63 / $396.00	Professional		$89.80	$135.63	$396.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.06 / $34.86 / $127.22	Professional	26	$23.06	$34.86	$127.22
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $41.31 / $50.72 / $122.67	Professional	52	$41.31	$50.72	$122.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.89 / $85.38 / $179.00	Professional	TC	$59.89	$85.38	$179.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.38 / $109.11 / $159.80	Professional		$76.38	$109.11	$159.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.37 / $31.88 / $60.79	Professional	26	$24.37	$31.88	$60.79
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $21.90 / $21.90 / $35.21	Professional	52	$21.90	$21.90	$35.21
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $69.56 / $99.58	Professional	TC	$43.65	$69.56	$99.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.01 / $84.41 / $118.91	Professional		$27.01	$84.41	$118.91
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $102.68 / $136.38 / $214.26	Professional		$102.68	$136.38	$214.26
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.86 / $33.18 / $89.65	Professional	26	$30.86	$33.18	$89.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.54 / $119.27 / $225.26	Professional		$87.54	$119.27	$225.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.87 / $35.08 / $65.68	Professional	26	$26.87	$35.08	$65.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.28 / $82.33 / $161.04	Professional	TC	$61.28	$82.33	$161.04
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $161.36 / $161.36	Facility	26	$100.00	$161.36	$161.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $234.59 / $778.42 / $987.60	Professional		$234.59	$778.42	$987.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $290.60 / $290.60 / $290.60	Professional	26	$290.60	$290.60	$290.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $570.15 / $570.15 / $723.68	Professional	TC	$570.15	$570.15	$723.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $52.49 / $155.99 / $242.40	Professional		$52.49	$155.99	$242.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.18 / $47.55 / $126.80	Professional	26	$37.18	$47.55	$126.80
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $142.77 / $142.77 / $149.10	Professional	52	$142.77	$142.77	$149.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.75 / $123.72 / $329.92	Professional	TC	$96.75	$123.72	$329.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $31.52 / $82.39 / $188.10	Professional		$31.52	$82.39	$188.10
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $92.29 / $121.20 / $261.72	Professional		$92.29	$121.20	$261.72
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.87 / $33.85 / $62.76	Professional	26	$26.87	$33.85	$62.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $60.76 / $80.97 / $156.38	Professional	TC	$60.76	$80.97	$156.38
United Facility/Professional Professional Modifier Low / Median / High Price $100.18 / $126.42 / $198.00	Professional		$100.18	$126.42	$198.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.09 / $36.28 / $55.56	Professional	26	$28.09	$36.28	$55.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.88 / $91.63 / $136.05	Professional	TC	$71.88	$91.63	$136.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $97.45 / $109.11 / $155.06	Professional		$97.45	$109.11	$155.06
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $27.05 / $31.17 / $43.64	Professional	26	$27.05	$31.17	$43.64
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $70.39 / $77.94 / $112.02	Professional	TC	$70.39	$77.94	$112.02