Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $18.20 / $26.30	Facility	26	$15.85	$18.20	$26.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $67.61 / $288.40	Professional		$54.95	$67.61	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.50 / $89.13	Professional	26	$15.85	$19.50	$89.13
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.88 / $104.71 / $263.03	Professional	50	$33.88	$104.71	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $44.67 / $64.57	Professional	TC	$37.15	$44.67	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $63.10 / $97.72	Professional		$52.48	$63.10	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $18.20 / $25.12	Professional	26	$15.85	$18.20	$25.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $14.79 / $43.65 / $74.13	Professional		$14.79	$43.65	$74.13
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $69.18 / $102.33	Professional		$58.88	$69.18	$102.33
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $25.12 / $25.12	Professional	26	$17.78	$25.12	$25.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $79.43 / $123.03	Professional		$57.54	$79.43	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $23.44 / $38.90	Professional	26	$17.78	$23.44	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $56.23 / $87.10	Professional	TC	$38.90	$56.23	$87.10
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $501.19 / $501.19	Professional		$416.87	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $144.54 / $144.54	Professional	26	$114.82	$144.54	$144.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $354.81 / $354.81	Professional	TC	$302.00	$354.81	$354.81
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $16.60 / $26.30	Facility	26	$14.13	$16.60	$26.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $67.61 / $151.36	Professional		$53.70	$67.61	$151.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.50 / $40.74	Professional	26	$15.85	$19.50	$40.74
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $104.71 / $263.03	Professional	50	$28.84	$104.71	$263.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $46.77 / $83.18	Professional	TC	$37.15	$46.77	$83.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $33.11 / $47.86	Professional		$14.45	$33.11	$47.86
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $67.61 / $154.88	Professional		$20.42	$67.61	$154.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $81.28 / $138.04	Professional		$57.54	$81.28	$138.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $23.99 / $38.02	Professional	26	$17.78	$23.99	$38.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $54.95 / $85.11	Professional	TC	$39.81	$54.95	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $66.07 / $107.15	Professional		$50.12	$66.07	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $20.42 / $32.36	Professional	26	$15.14	$20.42	$32.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $45.71 / $74.13	Professional	TC	$33.88	$45.71	$74.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $64.57 / $77.62	Professional		$45.71	$64.57	$77.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $18.62 / $22.39	Professional	26	$13.80	$18.62	$22.39
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $45.71 / $54.95	Professional	TC	$31.62	$45.71	$54.95