Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.69 / $29.26 / $51.30	Facility	26	$26.69	$29.26	$51.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.89 / $103.81 / $203.84	Professional		$56.89	$103.81	$203.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.69 / $34.61 / $63.25	Professional	26	$26.69	$34.61	$63.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.62 / $74.55 / $135.19	Professional	TC	$19.62	$74.55	$135.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $143.08 / $143.08 / $177.73	Professional		$143.08	$143.08	$177.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.80 / $41.80 / $41.80	Professional	26	$41.80	$41.80	$41.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.81 / $101.63 / $162.02	Professional		$35.81	$101.63	$162.02
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $126.95 / $155.63 / $205.62	Professional		$126.95	$155.63	$205.62
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $37.65 / $39.78 / $39.78	Professional	26	$37.65	$39.78	$39.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.38 / $120.19 / $225.98	Professional		$59.38	$120.19	$225.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.35 / $46.63 / $79.76	Professional	26	$34.35	$46.63	$79.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $83.73 / $144.91	Professional	TC	$15.14	$83.73	$144.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $92.97 / $200.31 / $200.31	Facility	26	$92.97	$200.31	$200.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $886.70 / $886.70 / $1,149.00	Professional		$886.70	$886.70	$1,149.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $414.43 / $414.43 / $414.43	Professional	26	$414.43	$414.43	$414.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $639.54 / $639.54 / $824.33	Professional	TC	$639.54	$639.54	$824.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $126.95 / $219.35 / $322.50	Professional		$126.95	$219.35	$322.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.47 / $64.05 / $88.33	Professional	26	$50.47	$64.05	$88.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.37 / $155.31 / $224.62	Professional	TC	$122.37	$155.31	$224.62
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $46.81 / $126.96 / $221.44	Professional		$46.81	$126.96	$221.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.06 / $127.19 / $241.44	Professional		$60.06	$127.19	$241.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.96 / $46.94 / $80.30	Professional	26	$34.96	$46.94	$80.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $15.32 / $83.73 / $151.01	Professional	TC	$15.32	$83.73	$151.01
United Facility/Professional Professional Modifier Low / Median / High Price $54.46 / $109.87 / $193.32	Professional		$54.46	$109.87	$193.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.25 / $49.74 / $69.33	Professional	26	$36.25	$49.74	$69.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.94 / $67.79 / $129.26	Professional	TC	$11.94	$67.79	$129.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $113.46 / $126.95 / $180.63	Professional		$113.46	$126.95	$180.63
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.13 / $38.00 / $52.73	Professional	26	$33.13	$38.00	$52.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $80.34 / $88.95 / $127.91	Professional	TC	$80.34	$88.95	$127.91