Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $660.66 / $660.66 / $660.66	Facility		$660.66	$660.66	$660.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.17 / $122.79 / $286.04	Professional		$95.17	$122.79	$286.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.62 / $67.13 / $274.75	Professional	26	$42.62	$67.13	$274.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.55 / $67.80 / $157.34	Professional	TC	$52.55	$67.80	$157.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $53.44 / $100.26 / $226.85	Professional		$53.44	$100.26	$226.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.83 / $64.20 / $101.03	Professional	26	$31.83	$64.20	$101.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $47.68 / $50.87 / $95.36	Professional	TC	$47.68	$50.87	$95.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.20 / $102.25 / $228.19	Professional		$76.20	$102.25	$228.19
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $97.50 / $159.57 / $255.31	Professional		$97.50	$159.57	$255.31
Christus Facility/Professional Facility Modifier Low / Median / High Price $68.05 / $158.94 / $161.21	Facility		$68.05	$158.94	$161.21
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $62.72 / $63.58 / $66.27	Professional	26	$62.72	$63.58	$66.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.98 / $88.24 / $283.26	Professional		$65.98	$88.24	$283.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.09 / $42.04 / $143.96	Professional	26	$33.09	$42.04	$143.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.46 / $50.22 / $165.75	Professional	TC	$33.46	$50.22	$165.75
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $420.88 / $905.83 / $905.83	Facility		$420.88	$905.83	$905.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $164.05 / $336.59 / $336.59	Facility	26	$164.05	$336.59	$336.59
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,961.76 / $1,961.76 / $1,961.76	Professional		$1,961.76	$1,961.76	$1,961.76
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $434.05 / $434.05 / $539.70	Professional	26	$434.05	$434.05	$539.70
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $557.54 / $557.54 / $887.33	Professional	TC	$557.54	$557.54	$887.33
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $83.20 / $168.04 / $247.85	Facility		$83.20	$168.04	$247.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $68.05 / $164.87 / $274.33	Professional		$68.05	$164.87	$274.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.68 / $98.01 / $166.52	Professional	26	$81.68	$98.01	$166.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.15 / $151.38 / $196.44	Professional	TC	$126.15	$151.38	$196.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $65.81 / $131.63 / $309.48	Professional		$65.81	$131.63	$309.48
Providence Facility/Professional Facility Modifier Low / Median / High Price $83.03 / $167.55 / $276.26	Facility		$83.03	$167.55	$276.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.22 / $124.76 / $392.68	Professional		$67.22	$124.76	$392.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.09 / $42.04 / $146.99	Professional	26	$33.09	$42.04	$146.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $33.46 / $50.22 / $158.09	Professional	TC	$33.46	$50.22	$158.09
United Facility/Professional Professional Modifier Low / Median / High Price $82.56 / $94.82 / $314.70	Professional		$82.56	$94.82	$314.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.64 / $44.93 / $147.96	Professional	26	$40.64	$44.93	$147.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.68 / $50.02 / $166.74	Professional	TC	$42.68	$50.02	$166.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $61.37 / $86.61 / $166.33	Professional		$61.37	$86.61	$166.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.85 / $35.04 / $65.73	Professional	26	$28.85	$35.04	$65.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $32.51 / $51.58 / $100.60	Professional	TC	$32.51	$51.58	$100.60