Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $141.25 / $165.96	Facility	26	$89.13	$141.25	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $478.63 / $1,412.54	Professional		$302.00	$478.63	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $165.96 / $426.58	Professional	26	$97.72	$165.96	$426.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $331.13 / $691.83	Professional	TC	$199.53	$331.13	$691.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $288.40 / $398.11	Professional		$223.87	$288.40	$398.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $107.15 / $199.53	Professional	26	$83.18	$107.15	$199.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $239.88 / $346.74	Professional	TC	$158.49	$239.88	$346.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $251.19 / $346.74	Professional		$89.13	$251.19	$346.74
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $446.68 / $1,202.26	Professional		$288.40	$446.68	$1,202.26
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $169.82 / $169.82	Professional	26	$102.33	$169.82	$169.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $123.03 / $177.83	Facility	26	$26.92	$123.03	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $512.86 / $1,318.26	Professional		$295.12	$512.86	$1,318.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $138.04 / $257.04	Professional	26	$91.20	$138.04	$257.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $354.81 / $1,000.00	Professional	TC	$204.17	$354.81	$1,000.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility	26	$1,000.00	$1,000.00	$1,000.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,309.57 / $6,309.57 / $6,309.57	Professional		$6,309.57	$6,309.57	$6,309.57
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $912.01 / $912.01 / $912.01	Professional	26	$912.01	$912.01	$912.01
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,754.40 / $5,754.40 / $5,754.40	Professional	TC	$5,754.40	$5,754.40	$5,754.40
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $134.90 / $165.96	Facility	26	$89.13	$134.90	$165.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $512.86 / $1,122.02	Professional		$323.59	$512.86	$1,122.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $165.96 / $363.08	Professional	26	$102.33	$165.96	$363.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $338.84 / $676.08	Professional	TC	$213.80	$338.84	$676.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $263.03	Professional		$32.36	$33.11	$263.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $302.00 / $831.76	Professional		$109.65	$302.00	$831.76
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $123.03 / $177.83	Facility	26	$26.92	$123.03	$177.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $537.03 / $1,148.15	Professional		$302.00	$537.03	$1,148.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $134.90 / $218.78	Professional	26	$91.20	$134.90	$218.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $346.74 / $954.99	Professional	TC	$199.53	$346.74	$954.99
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $478.63 / $1,023.29	Professional		$316.23	$478.63	$1,023.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $117.49 / $218.78	Professional	26	$95.50	$117.49	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $323.59 / $741.31	Professional	TC	$218.78	$323.59	$741.31
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $380.19	Professional		$302.00	$302.00	$380.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $107.15 / $128.82	Professional	26	$102.33	$107.15	$128.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $204.17 / $251.19	Professional	TC	$204.17	$204.17	$251.19