Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $22.39 / $26.30	Facility	26	$20.89	$22.39	$26.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $162.18 / $398.11	Professional		$102.33	$162.18	$398.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $37.15 / $112.20	Professional	26	$23.99	$37.15	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $100.00 / $186.21	Professional	TC	$70.79	$100.00	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $138.04 / $190.55	Professional		$93.33	$138.04	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.20 / $43.65	Professional	26	$24.55	$30.20	$43.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $95.50 / $117.49	Professional	TC	$52.48	$95.50	$117.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $102.33 / $138.04	Professional		$26.30	$102.33	$138.04
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $181.97 / $302.00	Professional		$131.83	$181.97	$302.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $30.90 / $31.62	Professional	26	$30.20	$30.90	$31.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $158.49 / $316.23	Professional		$102.33	$158.49	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $36.31 / $69.18	Professional	26	$26.92	$36.31	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $120.23 / $263.03	Professional	TC	$66.07	$120.23	$263.03
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $204.17 / $204.17 / $204.17	Facility	26	$204.17	$204.17	$204.17
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,174.90 / $1,174.90	Professional		$891.25	$1,174.90	$1,174.90
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $371.54 / $371.54 / $371.54	Professional	26	$371.54	$371.54	$371.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $933.25 / $933.25	Professional	TC	$691.83	$933.25	$933.25
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $22.39 / $26.30	Facility	26	$19.95	$22.39	$26.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $162.18 / $380.19	Professional		$104.71	$162.18	$380.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $39.81 / $89.13	Professional	26	$25.12	$39.81	$89.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $109.65 / $213.80	Professional	TC	$72.44	$109.65	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $33.11 / $169.82	Professional		$26.92	$33.11	$169.82
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $169.82 / $436.52	Professional		$117.49	$169.82	$436.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $162.18 / $371.54	Professional		$97.72	$162.18	$371.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $34.67 / $64.57	Professional	26	$26.92	$34.67	$64.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $120.23 / $245.47	Professional	TC	$64.57	$120.23	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $147.91 / $239.88	Professional		$97.72	$147.91	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $36.31 / $54.95	Professional	26	$27.54	$36.31	$54.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $112.20 / $177.83	Professional	TC	$64.57	$112.20	$177.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $120.23 / $144.54	Professional		$114.82	$120.23	$144.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $32.36 / $38.90	Professional	26	$30.90	$32.36	$38.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $89.13 / $104.71	Professional	TC	$83.18	$89.13	$104.71