Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.42 / $138.59 / $162.63	Facility	26	$87.42	$138.59	$162.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $391.80 / $550.00 / $966.00	Professional		$391.80	$550.00	$966.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.42 / $138.59 / $199.08	Professional	26	$87.42	$138.59	$199.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $304.38 / $417.57 / $664.06	Professional	TC	$304.38	$417.57	$664.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $352.94 / $372.80 / $788.22	Professional		$352.94	$372.80	$788.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.43 / $103.98 / $198.49	Professional	26	$81.43	$103.98	$198.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.87 / $347.31 / $513.69	Professional		$87.87	$347.31	$513.69
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $399.00 / $492.00 / $880.32	Professional		$399.00	$492.00	$880.32
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $100.77 / $100.77 / $107.89	Professional	26	$100.77	$100.77	$107.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.33 / $122.33 / $122.33	Facility	26	$122.33	$122.33	$122.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $396.11 / $667.10 / $1,419.28	Professional		$396.11	$667.10	$1,419.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.78 / $127.77 / $222.25	Professional	26	$83.78	$127.77	$222.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $305.72 / $539.73 / $1,218.96	Professional	TC	$305.72	$539.73	$1,218.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $781.84 / $981.20 / $1,000.96	Facility	26	$781.84	$981.20	$1,000.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,967.97 / $6,147.01 / $6,147.01	Professional		$5,967.97	$6,147.01	$6,147.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $937.83 / $937.83 / $937.83	Professional	26	$937.83	$937.83	$937.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,400.50 / $5,562.51 / $5,562.51	Professional	TC	$5,400.50	$5,562.51	$5,562.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $439.24 / $761.61 / $1,846.32	Professional		$439.24	$761.61	$1,846.32
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.56 / $170.79 / $414.04	Professional	26	$134.56	$170.79	$414.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $465.50 / $590.83 / $1,432.32	Professional	TC	$465.50	$590.83	$1,432.32
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $120.89 / $431.62 / $631.69	Professional		$120.89	$431.62	$631.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $122.33 / $122.33 / $122.33	Facility	26	$122.33	$122.33	$122.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $415.60 / $716.76 / $1,443.28	Professional		$415.60	$716.76	$1,443.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $89.74 / $128.03 / $217.13	Professional	26	$89.74	$128.03	$217.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $316.04 / $509.75 / $1,186.10	Professional	TC	$316.04	$509.75	$1,186.10
United Facility/Professional Professional Modifier Low / Median / High Price $475.69 / $674.74 / $1,294.07	Professional		$475.69	$674.74	$1,294.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.81 / $114.76 / $217.45	Professional	26	$91.81	$114.76	$217.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $358.01 / $537.02 / $972.46	Professional	TC	$358.01	$537.02	$972.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $393.12 / $439.24 / $625.62	Professional		$393.12	$439.24	$625.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.34 / $101.79 / $140.37	Professional	26	$88.34	$101.79	$140.37
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $304.77 / $356.27 / $1,400.00	Professional	TC	$304.77	$356.27	$1,400.00