Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.37 / $87.15 / $114.46	Facility	26	$71.37	$87.15	$114.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.66 / $309.31 / $688.48	Professional		$223.66	$309.31	$688.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.15 / $92.14 / $295.45	Professional	26	$74.15	$92.14	$295.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.29 / $213.56 / $449.39	Professional	TC	$149.29	$213.56	$449.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.75 / $224.84 / $348.00	Professional		$139.75	$224.84	$348.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.09 / $102.20 / $159.43	Professional	26	$65.09	$102.20	$159.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $147.19 / $147.19 / $235.79	Professional	TC	$147.19	$147.19	$235.79
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.56 / $211.61 / $317.49	Professional		$70.56	$211.61	$317.49
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $250.18 / $363.34 / $518.25	Professional		$250.18	$363.34	$518.25
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $80.94 / $85.64 / $121.60	Professional	26	$80.94	$85.64	$121.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $238.14 / $388.98 / $784.03	Professional		$238.14	$388.98	$784.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.80 / $97.53 / $180.14	Professional	26	$66.80	$97.53	$180.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.62 / $284.39 / $599.60	Professional	TC	$164.62	$284.39	$599.60
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $627.76 / $788.32 / $804.96	Facility	26	$627.76	$788.32	$804.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,183.14 / $3,278.63 / $3,278.63	Professional		$3,183.14	$3,278.63	$3,278.63
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $694.28 / $1,009.00 / $1,009.00	Professional	26	$694.28	$1,009.00	$1,009.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,699.58 / $2,780.57 / $2,780.57	Professional	TC	$2,699.58	$2,780.57	$2,780.57
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $116.76 / $361.22 / $777.40	Professional		$116.76	$361.22	$777.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $108.07 / $137.16 / $332.52	Professional	26	$108.07	$137.16	$332.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $253.15 / $321.30 / $778.92	Professional	TC	$253.15	$321.30	$778.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $93.87 / $239.57 / $474.16	Professional		$93.87	$239.57	$474.16
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $246.47 / $412.00 / $805.00	Professional		$246.47	$412.00	$805.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.48 / $93.87 / $176.47	Professional	26	$72.48	$93.87	$176.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $166.35 / $273.99 / $593.54	Professional	TC	$166.35	$273.99	$593.54
United Facility/Professional Professional Modifier Low / Median / High Price $259.79 / $369.41 / $658.16	Professional		$259.79	$369.41	$658.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.97 / $93.24 / $164.99	Professional	26	$76.97	$93.24	$164.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $171.78 / $268.27 / $429.46	Professional	TC	$171.78	$268.27	$429.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $223.06 / $250.18 / $354.89	Professional		$223.06	$250.18	$354.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.95 / $81.76 / $112.77	Professional	26	$70.95	$81.76	$112.77
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $152.11 / $177.78 / $1,100.00	Professional	TC	$152.11	$177.78	$1,100.00