Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.12 / $27.48 / $43.22	Facility	26	$21.12	$27.48	$43.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.04 / $122.59 / $349.80	Professional		$73.04	$122.59	$349.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.01 / $33.40 / $127.88	Professional	26	$23.01	$33.40	$127.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.31 / $81.96 / $173.71	Professional	TC	$50.31	$81.96	$173.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.03 / $97.19 / $138.74	Professional		$68.03	$97.19	$138.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.14 / $30.87 / $60.19	Professional	26	$24.14	$30.87	$60.19
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.14 / $53.06 / $66.31	Professional	TC	$37.14	$53.06	$66.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.73 / $74.41 / $104.94	Professional		$26.73	$74.41	$104.94
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $91.35 / $121.49 / $189.52	Professional		$91.35	$121.49	$189.52
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.55 / $33.18 / $79.92	Professional	26	$30.55	$33.18	$79.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.07 / $37.07 / $37.07	Facility	26	$37.07	$37.07	$37.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.27 / $113.06 / $214.21	Professional		$84.27	$113.06	$214.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.24 / $34.50 / $66.23	Professional	26	$26.24	$34.50	$66.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.61 / $78.58 / $155.84	Professional	TC	$56.61	$78.58	$155.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $98.17 / $159.51 / $171.00	Facility	26	$98.17	$159.51	$171.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $687.27 / $687.27 / $877.28	Professional		$687.27	$687.27	$877.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $254.27 / $254.27 / $261.08	Professional	26	$254.27	$254.27	$261.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $479.00 / $479.00 / $616.20	Professional	TC	$479.00	$479.00	$616.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $50.69 / $134.16 / $218.90	Professional		$50.69	$134.16	$218.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.81 / $47.07 / $125.52	Professional	26	$36.81	$47.07	$125.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.33 / $105.29 / $280.76	Professional	TC	$82.33	$105.29	$280.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $76.27 / $164.41	Professional		$32.29	$76.27	$164.41
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $37.07 / $37.07 / $37.07	Facility	26	$37.07	$37.07	$37.07
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.24 / $117.98 / $245.18	Professional		$85.24	$117.98	$245.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.24 / $33.50 / $61.89	Professional	26	$26.24	$33.50	$61.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.61 / $77.36 / $150.50	Professional	TC	$56.61	$77.36	$150.50
United Facility/Professional Professional Modifier Low / Median / High Price $89.22 / $118.32 / $177.59	Professional		$89.22	$118.32	$177.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.01 / $36.28 / $56.64	Professional	26	$28.01	$36.28	$56.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.64 / $82.63 / $122.41	Professional	TC	$61.64	$82.63	$122.41
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $86.69 / $97.19 / $137.91	Professional		$86.69	$97.19	$137.91
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $30.87 / $43.22	Professional	26	$26.78	$30.87	$43.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $59.91 / $66.31 / $95.31	Professional	TC	$59.91	$66.31	$95.31