Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.35 / $25.02 / $56.99	Facility	26	$19.35	$25.02	$56.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.67 / $73.79 / $217.70	Professional		$40.67	$73.79	$217.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.58 / $26.28 / $72.06	Professional	26	$20.58	$26.28	$72.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.19 / $23.26 / $96.83	Professional	TC	$12.19	$23.26	$96.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.34 / $42.31 / $110.43	Professional		$35.34	$42.31	$110.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $37.65 / $74.30	Professional	26	$20.05	$37.65	$74.30
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $60.59 / $60.59 / $60.59	Professional	50	$60.59	$60.59	$60.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $7.82 / $7.82 / $9.77	Professional	TC	$7.82	$7.82	$9.77
BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.92 / $43.92 / $69.79	Professional		$34.92	$43.92	$69.79
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $45.06 / $63.11 / $93.64	Professional		$45.06	$63.11	$93.64
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $39.83 / $42.22 / $48.30	Professional	26	$39.83	$42.22	$48.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.95 / $99.84 / $201.92	Professional		$44.95	$99.84	$201.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.83 / $36.02 / $64.77	Professional	26	$25.83	$36.02	$64.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $8.94 / $55.42 / $149.96	Professional	TC	$8.94	$55.42	$149.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.38 / $210.71 / $210.71	Facility	26	$101.38	$210.71	$210.71
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $558.63 / $575.39 / $575.39	Professional		$558.63	$575.39	$575.39
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $253.44 / $260.82 / $344.78	Professional	26	$253.44	$260.82	$344.78
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $430.88 / $443.81 / $443.81	Professional	TC	$430.88	$443.81	$443.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $51.75 / $72.45 / $207.00	Professional		$51.75	$72.45	$207.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.54 / $62.10 / $82.80	Professional	26	$45.54	$62.10	$82.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.14 / $16.55 / $60.39	Professional	TC	$12.14	$16.55	$60.39
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.55 / $49.07 / $89.20	Professional		$11.55	$49.07	$89.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.79 / $100.77 / $202.55	Professional		$45.79	$100.77	$202.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.83 / $36.02 / $61.07	Professional	26	$25.83	$36.02	$61.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $8.94 / $53.72 / $149.96	Professional	TC	$8.94	$53.72	$149.96
United Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $104.74 / $158.08	Professional		$67.84	$104.74	$158.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.76 / $33.72 / $54.61	Professional	26	$25.76	$33.72	$54.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.88 / $70.38 / $115.91	Professional	TC	$39.88	$70.38	$115.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $44.17 / $50.49 / $70.69	Professional		$44.17	$50.49	$70.69
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.33 / $40.71 / $56.99	Professional	26	$35.33	$40.71	$56.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $8.83 / $9.77 / $14.01	Professional	TC	$8.83	$9.77	$14.01