Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $338.84 / $691.83	Professional		$257.04	$338.84	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $218.78 / $707.95	Professional	26	$87.10	$218.78	$707.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $218.78 / $436.52	Professional	TC	$158.49	$218.78	$436.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $213.80 / $398.11	Professional		$199.53	$213.80	$398.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $131.83 / $186.21	Professional	26	$66.07	$131.83	$186.21
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $131.83 / $131.83	Professional	TC	$131.83	$131.83	$131.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $234.42 / $575.44	Professional		$75.86	$234.42	$575.44
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $501.19 / $676.08	Professional		$275.42	$501.19	$676.08
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Professional	26	$131.83	$131.83	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $251.19 / $741.31	Professional		$158.49	$251.19	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $97.72 / $309.03	Professional	26	$66.07	$97.72	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $158.49 / $501.19	Professional	TC	$89.13	$158.49	$501.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $891.25 / $891.25 / $891.25	Facility	26	$891.25	$891.25	$891.25
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,754.23 / $3,548.13 / $3,548.13	Professional		$2,754.23	$3,548.13	$3,548.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $891.25 / $1,122.02 / $1,122.02	Professional	26	$891.25	$1,122.02	$1,122.02
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,862.09 / $2,454.71 / $2,454.71	Professional	TC	$1,862.09	$2,454.71	$2,454.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $436.52 / $776.25	Professional		$263.03	$436.52	$776.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $169.82 / $489.78	Professional	26	$87.10	$169.82	$489.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $275.42 / $524.81	Professional	TC	$173.78	$275.42	$524.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $363.08	Professional		$32.36	$33.11	$363.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $416.87 / $851.14	Professional		$141.25	$416.87	$851.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $263.03 / $794.33	Professional		$165.96	$263.03	$794.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $81.28 / $302.00	Professional	26	$66.07	$81.28	$302.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $154.88 / $501.19	Professional	TC	$97.72	$154.88	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $851.14	Professional		$194.98	$281.84	$851.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $93.33 / $302.00	Professional	26	$83.18	$93.33	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $190.55 / $549.54	Professional	TC	$109.65	$190.55	$549.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $165.96 / $416.87	Professional		$165.96	$165.96	$416.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $58.88 / $134.90	Professional	26	$58.88	$58.88	$134.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $107.15 / $275.42	Professional	TC	$107.15	$107.15	$275.42