Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.58 / $13.69 / $14.91	Facility	26	$13.58	$13.69	$14.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.60 / $70.06 / $180.48	Professional		$50.60	$70.06	$180.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.69 / $19.64 / $46.77	Professional	26	$13.69	$19.64	$46.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.46 / $46.36 / $95.34	Professional	TC	$36.46	$46.36	$95.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.47 / $91.32 / $98.10	Professional		$72.47	$91.32	$98.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.64 / $23.57 / $27.50	Professional	26	$19.64	$23.57	$27.50
BCBS Facility/Professional Professional Modifier Low / Median / High Price $18.32 / $56.94 / $84.30	Professional		$18.32	$56.94	$84.30
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $70.06 / $88.02 / $141.94	Professional		$70.06	$88.02	$141.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $67.55 / $67.55	Professional		$67.55	$67.55	$67.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $18.45 / $18.45	Professional	26	$18.45	$18.45	$18.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $49.10 / $49.10	Professional	TC	$49.10	$49.10	$49.10
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.24 / $104.06 / $104.06	Facility	26	$39.24	$104.06	$104.06
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $468.55 / $468.55 / $636.15	Professional		$468.55	$468.55	$636.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $126.27 / $126.27 / $168.23	Professional	26	$126.27	$126.27	$168.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $342.28 / $342.28 / $467.93	Professional	TC	$342.28	$342.28	$467.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.06 / $121.16 / $165.22	Professional		$70.06	$121.16	$165.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.07 / $33.08 / $40.27	Professional	26	$26.07	$33.08	$40.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.38 / $88.06 / $112.55	Professional	TC	$69.38	$88.06	$112.55
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $73.86 / $129.81	Professional		$24.55	$73.86	$129.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $67.55 / $67.55	Professional		$67.55	$67.55	$67.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $18.45 / $18.45	Professional	26	$18.45	$18.45	$18.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $49.10 / $49.10	Professional	TC	$49.10	$49.10	$49.10
United Facility/Professional Professional Modifier Low / Median / High Price $68.31 / $98.38 / $160.58	Professional		$68.31	$98.38	$160.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.67 / $23.42 / $35.58	Professional	26	$17.67	$23.42	$35.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.02 / $72.25 / $137.37	Professional	TC	$50.02	$72.25	$137.37
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $62.67 / $70.06 / $99.71	Professional		$62.67	$70.06	$99.71
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.11 / $19.64 / $27.22	Professional	26	$17.11	$19.64	$27.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $45.55 / $50.43 / $72.50	Professional	TC	$45.55	$50.43	$72.50