Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $26.92 / $48.98	Facility	26	$24.55	$26.92	$48.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $275.42 / $549.54	Professional		$181.97	$275.42	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $43.65 / $95.50	Professional	26	$26.92	$43.65	$95.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $213.80 / $380.19	Professional	TC	$151.36	$213.80	$380.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $239.88 / $309.03	Professional		$199.53	$239.88	$309.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $39.81 / $50.12	Professional	26	$35.48	$39.81	$50.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $234.42 / $234.42	Professional	TC	$234.42	$234.42	$234.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $218.78 / $288.40	Professional		$37.15	$218.78	$288.40
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $309.03 / $416.87	Professional		$245.47	$309.03	$416.87
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $38.02 / $38.02	Professional	26	$35.48	$38.02	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $275.42 / $524.81	Professional		$194.98	$275.42	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $43.65 / $72.44	Professional	26	$32.36	$43.65	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $234.42 / $446.68	Professional	TC	$154.88	$234.42	$446.68
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $467.74 / $467.74 / $467.74	Facility	26	$467.74	$467.74	$467.74
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Professional		$2,398.83	$2,398.83	$2,398.83
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $724.44 / $724.44 / $724.44	Professional	26	$724.44	$724.44	$724.44
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,659.59 / $1,949.84 / $1,949.84	Professional	TC	$1,659.59	$1,949.84	$1,949.84
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $26.92 / $48.98	Facility	26	$25.12	$26.92	$48.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $331.13 / $645.65	Professional		$186.21	$331.13	$645.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $51.29 / $97.72	Professional	26	$26.92	$51.29	$97.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $281.84 / $524.81	Professional	TC	$158.49	$281.84	$524.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $33.11 / $223.87	Professional		$31.62	$33.11	$223.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $489.78 / $537.03	Professional		$407.38	$489.78	$537.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $275.42 / $501.19	Professional		$186.21	$275.42	$501.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $70.79	Professional	26	$31.62	$42.66	$70.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $234.42 / $426.58	Professional	TC	$144.54	$234.42	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $269.15 / $446.68	Professional		$213.80	$269.15	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $41.69 / $63.10	Professional	26	$32.36	$41.69	$63.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $229.09 / $380.19	Professional	TC	$177.83	$229.09	$380.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $257.04 / $269.15	Professional		$257.04	$257.04	$269.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $37.15	Professional	26	$36.31	$36.31	$37.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $218.78 / $229.09	Professional	TC	$218.78	$218.78	$229.09