Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $112.20 / $229.09	Professional		$81.28	$112.20	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $39.81 / $234.42	Professional	26	$25.12	$39.81	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $81.28 / $162.18	Professional	TC	$57.54	$81.28	$162.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $72.44	Professional		$72.44	$72.44	$72.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $19.95 / $40.74	Professional	26	$19.95	$19.95	$40.74
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	TC	$50.12	$50.12	$50.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $75.86 / $204.17	Professional		$53.70	$75.86	$204.17
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $186.21 / $223.87	Professional		$138.04	$186.21	$223.87
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $39.81 / $39.81	Professional	26	$38.90	$39.81	$39.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $109.65 / $275.42	Professional		$64.57	$109.65	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $33.11 / $93.33	Professional	26	$19.95	$33.11	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $79.43 / $199.53	Professional	TC	$42.66	$79.43	$199.53
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	26	$269.15	$269.15	$269.15
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,258.93 / $1,258.93	Professional		$1,071.52	$1,258.93	$1,258.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Professional	26	$389.05	$389.05	$389.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $794.33 / $912.01 / $912.01	Professional	TC	$794.33	$912.01	$912.01
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $169.82 / $275.42	Professional		$81.28	$169.82	$275.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $52.48 / $158.49	Professional	26	$25.12	$52.48	$158.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $123.03 / $199.53	Professional	TC	$57.54	$123.03	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $125.89	Professional		$32.36	$33.11	$125.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $144.54 / $295.12	Professional		$42.66	$144.54	$295.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $109.65 / $363.08	Professional		$63.10	$109.65	$363.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $30.90 / $93.33	Professional	26	$19.95	$30.90	$93.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $72.44 / $190.55	Professional	TC	$41.69	$72.44	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $114.82 / $288.40	Professional		$77.62	$114.82	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $38.90 / $97.72	Professional	26	$25.70	$38.90	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $75.86 / $190.55	Professional	TC	$51.29	$75.86	$190.55
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $52.48 / $144.54	Professional		$52.48	$52.48	$144.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $16.98 / $40.74	Professional	26	$16.98	$16.98	$40.74
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $35.48 / $104.71	Professional	TC	$35.48	$35.48	$104.71