Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.69 / $133.99 / $167.36	Facility	26	$88.69	$133.99	$167.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $278.62 / $454.97 / $831.76	Professional		$278.62	$454.97	$831.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.69 / $140.72 / $421.00	Professional	26	$88.69	$140.72	$421.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $139.31 / $212.50 / $319.00	Professional	52	$139.31	$212.50	$319.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $189.93 / $322.39 / $565.00	Professional	TC	$189.93	$322.39	$565.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $214.61 / $270.25 / $627.84	Professional		$214.61	$270.25	$627.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.45 / $113.38 / $200.98	Professional	26	$82.45	$113.38	$200.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $117.95 / $168.24 / $221.15	Professional	TC	$117.95	$168.24	$221.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.97 / $239.34 / $382.68	Professional		$88.97	$239.34	$382.68
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $300.11 / $455.00 / $817.74	Professional		$300.11	$455.00	$817.74
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $102.03 / $107.79 / $179.80	Professional	26	$102.03	$107.79	$179.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $270.25 / $500.00 / $1,255.65	Professional		$270.25	$500.00	$1,255.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.10 / $132.85 / $229.94	Professional	26	$85.10	$132.85	$229.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $178.76 / $346.50 / $999.64	Professional	TC	$178.76	$346.50	$999.64
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $791.52 / $993.60 / $1,013.76	Facility	26	$791.52	$993.60	$1,013.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,146.58 / $6,330.97 / $6,330.97	Professional		$6,146.58	$6,330.97	$6,330.97
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $921.60 / $921.60 / $921.60	Professional	26	$921.60	$921.60	$921.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,551.18 / $5,717.71 / $5,717.71	Professional	TC	$5,551.18	$5,717.71	$5,717.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $169.15 / $469.99 / $1,436.25	Professional		$169.15	$469.99	$1,436.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $136.24 / $172.92 / $419.20	Professional	26	$136.24	$172.92	$419.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $272.06 / $345.31 / $837.12	Professional	TC	$272.06	$345.31	$837.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $115.75 / $252.74 / $567.77	Professional		$115.75	$252.74	$567.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $279.50 / $554.16 / $1,125.74	Professional		$279.50	$554.16	$1,125.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $91.28 / $134.26 / $226.02	Professional	26	$91.28	$134.26	$226.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $183.57 / $345.58 / $921.87	Professional	TC	$183.57	$345.58	$921.87
United Facility/Professional Professional Modifier Low / Median / High Price $315.04 / $447.26 / $1,002.95	Professional		$315.04	$447.26	$1,002.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.83 / $117.13 / $219.30	Professional	26	$93.83	$117.13	$219.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $202.68 / $304.02 / $721.18	Professional	TC	$202.68	$304.02	$721.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $268.06 / $300.83 / $426.48	Professional		$268.06	$300.83	$426.48
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $89.44 / $103.07 / $142.13	Professional	26	$89.44	$103.07	$142.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $178.61 / $208.77 / $1,400.00	Professional	TC	$178.61	$208.77	$1,400.00