Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $154.88 / $165.96	Facility	26	$147.91	$154.88	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $489.78 / $1,258.93	Professional		$338.84	$489.78	$1,258.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $263.03 / $660.69	Professional	26	$165.96	$263.03	$660.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $245.47 / $446.68	Professional	TC	$169.82	$245.47	$446.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $489.78 / $707.95	Professional		$309.03	$489.78	$707.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $177.83 / $223.87 / $295.12	Professional	26	$177.83	$223.87	$295.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $371.54 / $602.56	Professional		$177.83	$371.54	$602.56
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $478.63 / $741.31	Professional		$446.68	$478.63	$741.31
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $229.09 / $229.09	Professional	26	$213.80	$229.09	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $562.34 / $933.25	Professional		$407.38	$562.34	$933.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $269.15 / $446.68	Professional	26	$194.98	$269.15	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $316.23 / $537.03	Professional	TC	$213.80	$316.23	$537.03
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,412.54 / $1,412.54 / $1,412.54	Facility	26	$1,412.54	$1,412.54	$1,412.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,884.03 / $3,981.07 / $3,981.07	Professional		$2,884.03	$3,981.07	$3,981.07
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,412.54 / $1,862.09 / $1,862.09	Professional	26	$1,412.54	$1,862.09	$1,862.09
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,479.11 / $2,137.96 / $2,137.96	Professional	TC	$1,479.11	$2,137.96	$2,137.96
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $151.36 / $154.88 / $165.96	Facility	26	$151.36	$154.88	$165.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $562.34 / $1,174.90	Professional		$338.84	$562.34	$1,174.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $316.23 / $602.56	Professional	26	$165.96	$316.23	$602.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $323.59 / $549.54	Professional	TC	$162.18	$323.59	$549.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $389.05	Professional		$32.36	$33.11	$389.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $851.14 / $977.24	Professional		$707.95	$851.14	$977.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $549.54 / $933.25	Professional		$407.38	$549.54	$933.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $257.04 / $426.58	Professional	26	$190.55	$257.04	$426.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $309.03 / $524.81	Professional	TC	$208.93	$309.03	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $616.60 / $812.83	Professional		$436.52	$616.60	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $288.40 / $371.54	Professional	26	$194.98	$288.40	$371.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $331.13 / $446.68	Professional	TC	$239.88	$331.13	$446.68
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $478.63	Professional		$457.09	$457.09	$478.63
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $218.78 / $229.09	Professional	26	$218.78	$218.78	$229.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $251.19 / $251.19	Professional	TC	$251.19	$251.19	$251.19