Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.45 / $90.26 / $92.67	Facility	26	$57.45	$90.26	$92.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.06 / $451.98 / $740.71	Professional		$288.06	$451.98	$740.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $106.48 / $228.59	Professional	26	$62.50	$106.48	$228.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $230.60 / $335.00 / $565.00	Professional	TC	$230.60	$335.00	$565.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $247.59 / $262.16 / $556.10	Professional		$247.59	$262.16	$556.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.95 / $93.06 / $129.07	Professional	26	$52.95	$93.06	$129.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $243.30 / $243.30 / $243.30	Professional	TC	$243.30	$243.30	$243.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.94 / $253.82 / $384.75	Professional		$59.94	$253.82	$384.75
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $307.00 / $433.29 / $618.98	Professional		$307.00	$433.29	$618.98
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $65.52 / $65.52 / $70.53	Professional	26	$65.52	$65.52	$70.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $278.55 / $557.30 / $1,297.00	Professional		$278.55	$557.30	$1,297.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.26 / $93.10 / $175.55	Professional	26	$56.26	$93.10	$175.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $220.14 / $445.53 / $1,133.69	Professional	TC	$220.14	$445.53	$1,133.69
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $507.76 / $638.88 / $656.72	Facility	26	$507.76	$638.88	$656.72
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,311.18 / $5,470.52 / $5,470.52	Professional		$5,311.18	$5,470.52	$5,470.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $808.00 / $808.00 / $808.00	Professional	26	$808.00	$808.00	$808.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $4,858.99 / $5,004.77 / $5,004.77	Professional	TC	$4,858.99	$5,004.77	$5,004.77
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $119.89 / $487.14 / $1,299.04	Professional		$119.89	$487.14	$1,299.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.46 / $111.01 / $269.12	Professional	26	$87.46	$111.01	$269.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $334.72 / $424.84 / $1,029.92	Professional	TC	$334.72	$424.84	$1,029.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.81 / $321.61 / $596.29	Professional		$75.81	$321.61	$596.29
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $303.32 / $620.07 / $1,254.96	Professional		$303.32	$620.07	$1,254.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.59 / $92.41 / $172.14	Professional	26	$58.59	$92.41	$172.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $224.95 / $426.98 / $1,118.36	Professional	TC	$224.95	$426.98	$1,118.36
United Facility/Professional Professional Modifier Low / Median / High Price $320.88 / $542.33 / $1,032.77	Professional		$320.88	$542.33	$1,032.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $80.80 / $144.69	Professional	26	$64.73	$80.80	$144.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $261.54 / $470.27 / $861.41	Professional	TC	$261.54	$470.27	$861.41
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $277.17 / $309.49 / $441.13	Professional		$277.17	$309.49	$441.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.42 / $66.19 / $91.33	Professional	26	$57.42	$66.19	$91.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $219.75 / $256.83 / $1,400.00	Professional	TC	$219.75	$256.83	$1,400.00