Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $25.12 / $26.92	Facility	26	$19.05	$25.12	$26.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $107.15 / $275.42	Professional		$83.18	$107.15	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $33.88 / $199.53	Professional	26	$20.89	$33.88	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $79.43 / $213.80	Professional	TC	$61.66	$79.43	$213.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $91.20 / $144.54	Professional		$58.88	$91.20	$144.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $26.92 / $35.48	Professional	26	$15.49	$26.92	$35.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $44.67	Professional	TC	$44.67	$44.67	$44.67
BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $69.18 / $173.78	Professional		$17.78	$69.18	$173.78
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $147.91 / $194.98	Professional		$83.18	$147.91	$194.98
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $30.90 / $31.62	Professional	26	$30.90	$30.90	$31.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $70.79 / $229.09	Professional		$46.77	$70.79	$229.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $18.20 / $58.88	Professional	26	$12.88	$18.20	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $53.70 / $165.96	Professional	TC	$33.11	$53.70	$165.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,071.52 / $1,071.52	Professional		$870.96	$1,071.52	$1,071.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $263.03 / $263.03	Professional	26	$213.80	$263.03	$263.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $812.83 / $812.83	Professional	TC	$660.69	$812.83	$812.83
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $20.89 / $25.70	Facility	26	$19.05	$20.89	$25.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $125.89 / $263.03	Professional		$81.28	$125.89	$263.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $35.48 / $85.11	Professional	26	$19.95	$35.48	$85.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $95.50 / $186.21	Professional	TC	$61.66	$95.50	$186.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $33.11 / $102.33	Professional		$31.62	$33.11	$102.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $117.49 / $257.04	Professional		$33.88	$117.49	$257.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $70.79 / $245.47	Professional		$45.71	$70.79	$245.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $18.20 / $57.54	Professional	26	$12.88	$18.20	$57.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $53.70 / $165.96	Professional	TC	$31.62	$53.70	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $85.11 / $229.09	Professional		$58.88	$85.11	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.88 / $60.26	Professional	26	$16.22	$21.88	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $63.10 / $169.82	Professional	TC	$41.69	$63.10	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $120.23 / $125.89	Professional		$54.95	$120.23	$125.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $30.90 / $31.62	Professional	26	$14.13	$30.90	$31.62
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $89.13 / $93.33	Professional	TC	$40.74	$89.13	$93.33