Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $169.82 / $269.15	Facility	26	$165.96	$169.82	$269.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $323.59 / $691.83	Professional		$263.03	$323.59	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $194.98 / $457.09	Professional	26	$165.96	$194.98	$457.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $112.20 / $162.18	Professional	TC	$93.33	$112.20	$162.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $295.12 / $371.54	Professional		$257.04	$295.12	$371.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $181.97 / $239.88	Professional	26	$165.96	$181.97	$239.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $229.09 / $354.81	Professional		$147.91	$229.09	$354.81
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $331.13 / $478.63	Professional		$295.12	$331.13	$478.63
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $257.04 / $257.04	Professional	26	$181.97	$257.04	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $389.05 / $630.96	Professional		$281.84	$389.05	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $239.88 / $398.11	Professional	26	$181.97	$239.88	$398.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $144.54 / $234.42	Professional	TC	$100.00	$144.54	$234.42
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Facility	26	$1,174.90	$1,174.90	$1,174.90
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,344.23 / $2,344.23	Professional		$1,862.09	$2,344.23	$2,344.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,174.90 / $1,479.11 / $1,479.11	Professional	26	$1,174.90	$1,479.11	$1,479.11
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $851.14 / $851.14	Professional	TC	$691.83	$851.14	$851.14
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $169.82 / $269.15	Facility	26	$141.25	$169.82	$269.15
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $323.59 / $602.56	Professional		$263.03	$323.59	$602.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $194.98 / $371.54	Professional	26	$169.82	$194.98	$371.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $199.53	Professional	TC	$93.33	$114.82	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $81.28 / $239.88	Professional		$32.36	$81.28	$239.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $346.74 / $691.83	Professional		$125.89	$346.74	$691.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $398.11 / $660.69	Professional		$281.84	$398.11	$660.69
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $245.47 / $389.05	Professional	26	$181.97	$245.47	$389.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $144.54 / $229.09	Professional	TC	$100.00	$144.54	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $331.13 / $537.03	Professional		$245.47	$331.13	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $204.17 / $331.13	Professional	26	$154.88	$204.17	$331.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $125.89 / $204.17	Professional	TC	$93.33	$125.89	$204.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $302.00 / $363.08	Professional		$218.78	$302.00	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $190.55 / $229.09	Professional	26	$141.25	$190.55	$229.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $112.20 / $131.83	Professional	TC	$77.62	$112.20	$131.83