Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $91.20 / $120.23	Facility	26	$57.54	$91.20	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $478.63 / $1,096.48	Professional		$309.03	$478.63	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $114.82 / $257.04	Professional	26	$66.07	$114.82	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $363.08 / $707.95	Professional	TC	$239.88	$363.08	$707.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $245.47 / $389.05	Professional		$204.17	$245.47	$389.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $69.18 / $138.04	Professional	26	$53.70	$69.18	$138.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $263.03 / $338.84	Professional		$57.54	$263.03	$338.84
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $323.59 / $501.19	Professional		$275.42	$323.59	$501.19
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $66.07 / $70.79	Professional	26	$66.07	$66.07	$70.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $575.44 / $1,348.96	Professional		$309.03	$575.44	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $97.72 / $190.55	Professional	26	$58.88	$97.72	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $478.63 / $1,148.15	Professional	TC	$245.47	$478.63	$1,148.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	26	$645.65	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,495.41 / $5,495.41 / $5,495.41	Professional		$5,495.41	$5,495.41	$5,495.41
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $812.83 / $812.83 / $812.83	Professional	26	$812.83	$812.83	$812.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,011.87 / $5,011.87 / $5,011.87	Professional	TC	$5,011.87	$5,011.87	$5,011.87
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $91.20 / $120.23	Facility	26	$57.54	$91.20	$120.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $501.19 / $1,071.52	Professional		$331.13	$501.19	$1,071.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $117.49 / $245.47	Professional	26	$69.18	$117.49	$245.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $371.54 / $776.25	Professional	TC	$251.19	$371.54	$776.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $275.42	Professional		$32.36	$33.11	$275.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $338.84 / $1,513.56	Professional		$72.44	$338.84	$1,513.56
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $588.84 / $1,258.93	Professional		$309.03	$588.84	$1,258.93
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $95.50 / $165.96	Professional	26	$58.88	$95.50	$165.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $426.58 / $1,122.02	Professional	TC	$239.88	$426.58	$1,122.02
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $588.84 / $1,023.29	Professional		$331.13	$588.84	$1,023.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $77.62 / $144.54	Professional	26	$64.57	$77.62	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $478.63 / $870.96	Professional	TC	$263.03	$478.63	$870.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $316.23 / $389.05	Professional		$316.23	$316.23	$389.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $69.18 / $83.18	Professional	26	$66.07	$69.18	$83.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $245.47 / $309.03	Professional	TC	$245.47	$245.47	$309.03