Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.09 / $19.92 / $34.75	Facility	26	$16.09	$19.92	$34.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.51 / $111.23 / $459.00	Professional		$79.51	$111.23	$459.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.73 / $28.45 / $112.00	Professional	26	$19.73	$28.45	$112.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.31 / $78.39 / $136.69	Professional	TC	$50.31	$78.39	$136.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.15 / $95.01 / $117.24	Professional		$72.15	$95.01	$117.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.28 / $23.76 / $42.14	Professional	26	$16.28	$23.76	$42.14
BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.05 / $69.73 / $133.68	Professional		$21.05	$69.73	$133.68
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $95.01 / $122.67 / $166.85	Professional		$95.01	$122.67	$166.85
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $23.01 / $34.79 / $34.79	Professional	26	$23.01	$34.79	$34.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.20 / $28.20 / $28.20	Facility	26	$28.20	$28.20	$28.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.58 / $134.78 / $213.29	Professional		$101.58	$134.78	$213.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.56 / $34.52 / $55.68	Professional	26	$25.56	$34.52	$55.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.79 / $99.83 / $161.32	Professional	TC	$76.79	$99.83	$161.32
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $119.99 / $136.00	Facility	26	$100.00	$119.99	$136.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $698.76 / $698.76 / $817.73	Professional		$698.76	$698.76	$817.73
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $226.20 / $279.51 / $279.51	Professional	26	$226.20	$279.51	$279.51
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $479.00 / $479.00 / $621.90	Professional	TC	$479.00	$479.00	$621.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $38.27 / $130.27 / $175.68	Professional		$38.27	$130.27	$175.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $37.78 / $55.59	Professional	26	$29.51	$37.78	$55.59
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $88.55 / $116.89 / $175.68	Professional	TC	$88.55	$116.89	$175.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.29 / $94.78 / $173.17	Professional		$27.29	$94.78	$173.17
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $28.20 / $28.20 / $28.20	Facility	26	$28.20	$28.20	$28.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $100.89 / $138.07 / $244.64	Professional		$100.89	$138.07	$244.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.34 / $34.29 / $52.22	Professional	26	$25.34	$34.29	$52.22
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $76.37 / $98.41 / $152.09	Professional	TC	$76.37	$98.41	$152.09
United Facility/Professional Professional Modifier Low / Median / High Price $81.42 / $114.57 / $195.00	Professional		$81.42	$114.57	$195.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.70 / $27.67 / $46.80	Professional	26	$20.70	$27.67	$46.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.29 / $86.45 / $145.59	Professional	TC	$61.29	$86.45	$145.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $80.61 / $90.19 / $128.26	Professional		$80.61	$90.19	$128.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.14 / $23.25 / $32.54	Professional	26	$20.14	$23.25	$32.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $60.46 / $66.94 / $96.19	Professional	TC	$60.46	$66.94	$96.19