Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.74 / $109.05 / $155.57	Facility	26	$100.74	$109.05	$155.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $318.13 / $381.75 / $600.96	Professional		$318.13	$381.75	$600.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.32 / $109.05 / $179.88	Professional	26	$98.32	$109.05	$179.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $150.02 / $213.01 / $320.01	Professional	52	$150.02	$213.01	$320.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $215.85 / $277.27 / $401.49	Professional	TC	$215.85	$277.27	$401.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $330.37 / $382.95 / $382.95	Professional		$330.37	$382.95	$382.95
BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.77 / $259.50 / $466.04	Professional		$82.77	$259.50	$466.04
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $709.95 / $743.33 / $743.33	Professional		$709.95	$743.33	$743.33
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $102.61 / $139.30 / $139.30	Professional	26	$102.61	$139.30	$139.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $335.59 / $441.40 / $693.96	Professional		$335.59	$441.40	$693.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.34 / $140.08 / $216.71	Professional	26	$108.34	$140.08	$216.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $230.61 / $305.52 / $493.58	Professional	TC	$230.61	$305.52	$493.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $240.28 / $463.23 / $498.13	Facility	26	$240.28	$463.23	$498.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,444.00 / $2,698.08 / $2,846.03	Professional		$2,444.00	$2,698.08	$2,846.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $752.32 / $770.56 / $835.28	Professional	26	$752.32	$770.56	$835.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,747.81 / $1,927.52 / $2,010.75	Professional	TC	$1,747.81	$1,927.52	$2,010.75
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $314.25 / $502.82 / $591.54	Professional		$314.25	$502.82	$591.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.66 / $151.44 / $178.16	Professional	26	$128.66	$151.44	$178.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $298.56 / $351.38 / $413.39	Professional	TC	$298.56	$351.38	$413.39
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $323.30 / $323.30 / $323.30	Professional		$323.30	$323.30	$323.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $336.11 / $456.68 / $768.05	Professional		$336.11	$456.68	$768.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $109.71 / $141.83 / $216.71	Professional	26	$109.71	$141.83	$216.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $230.61 / $305.52 / $507.61	Professional	TC	$230.61	$305.52	$507.61
United Facility/Professional Professional Modifier Low / Median / High Price $264.19 / $367.83 / $596.57	Professional		$264.19	$367.83	$596.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.19 / $119.89 / $185.28	Professional	26	$87.19	$119.89	$185.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $176.77 / $251.38 / $415.22	Professional	TC	$176.77	$251.38	$415.22
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $280.48 / $314.25 / $446.00	Professional		$280.48	$314.25	$446.00
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $84.48 / $97.23 / $133.91	Professional	26	$84.48	$97.23	$133.91
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $196.01 / $217.02 / $312.08	Professional	TC	$196.01	$217.02	$312.08