Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $30.20 / $87.10	Facility	26	$22.91	$30.20	$87.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $151.36 / $467.74	Professional		$100.00	$151.36	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $44.67 / $120.23	Professional	26	$30.20	$44.67	$120.23
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $70.79 / $562.34	Professional	52	$30.20	$70.79	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $97.72 / $223.87	Professional	TC	$72.44	$97.72	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $102.33 / $165.96	Professional		$83.18	$102.33	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $33.88 / $58.88	Professional	26	$26.92	$33.88	$58.88
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.99 / $25.12 / $50.12	Professional	52	$23.99	$25.12	$50.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $83.18 / $125.89	Professional	TC	$60.26	$83.18	$125.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $100.00 / $134.90	Professional		$29.51	$100.00	$134.90
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $147.91 / $204.17	Professional		$112.20	$147.91	$204.17
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $38.02 / $38.02	Professional	26	$33.88	$38.02	$38.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $41.69 / $58.88	Facility	26	$8.91	$41.69	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $147.91 / $275.42	Professional		$102.33	$147.91	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $41.69 / $79.43	Professional	26	$29.51	$41.69	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $109.65 / $208.93	Professional	TC	$75.86	$109.65	$208.93
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $831.76 / $1,071.52	Professional		$141.25	$831.76	$1,071.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $288.40 / $288.40	Professional	26	$229.09	$288.40	$288.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $776.25 / $776.25	Professional	TC	$602.56	$776.25	$776.25
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $30.20 / $54.95	Facility	26	$22.91	$30.20	$54.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $158.49 / $371.54	Professional		$100.00	$158.49	$371.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $44.67 / $114.82	Professional	26	$28.84	$44.67	$114.82
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $30.90 / $89.13 / $562.34	Professional	52	$30.90	$89.13	$562.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $107.15 / $218.78	Professional	TC	$72.44	$107.15	$218.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $33.11 / $102.33	Professional		$30.20	$33.11	$102.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $102.33 / $229.09	Professional		$36.31	$102.33	$229.09
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $41.69 / $58.88	Facility	26	$8.91	$41.69	$58.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $144.54 / $295.12	Professional		$102.33	$144.54	$295.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $38.90 / $67.61	Professional	26	$29.51	$38.90	$67.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $100.00 / $177.83	Professional	TC	$74.13	$100.00	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $229.09	Professional		$112.20	$151.36	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $41.69 / $64.57	Professional	26	$31.62	$41.69	$64.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $109.65 / $165.96	Professional	TC	$81.28	$109.65	$165.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $125.89 / $151.36	Professional		$120.23	$125.89	$151.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $35.48 / $42.66	Professional	26	$35.48	$35.48	$42.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $91.20 / $107.15	Professional	TC	$87.10	$91.20	$107.15