Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.64 / $108.30 / $131.36	Facility	26	$69.64	$108.30	$131.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $297.06 / $461.17 / $634.99	Professional		$297.06	$461.17	$634.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.64 / $118.81 / $285.00	Professional	26	$69.64	$118.81	$285.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $224.15 / $335.00 / $489.03	Professional	TC	$224.15	$335.00	$489.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.18 / $112.66 / $137.69	Professional	26	$64.18	$112.66	$137.69
BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.09 / $254.51 / $400.10	Professional		$72.09	$254.51	$400.10
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $328.47 / $372.00 / $395.00	Professional		$328.47	$372.00	$395.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.40 / $79.40 / $85.98	Professional	26	$79.40	$79.40	$85.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.95 / $96.95 / $96.95	Facility	26	$96.95	$96.95	$96.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.24 / $487.80 / $875.30	Professional		$281.24	$487.80	$875.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.80 / $102.80 / $183.36	Professional	26	$65.80	$102.80	$183.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $210.31 / $373.65 / $716.89	Professional	TC	$210.31	$373.65	$716.89
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $614.96 / $774.40 / $793.04	Facility	26	$614.96	$774.40	$793.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,032.66 / $3,043.62 / $3,048.68	Professional		$3,032.66	$3,043.62	$3,048.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $854.80 / $854.80 / $854.80	Professional	26	$854.80	$854.80	$854.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,562.41 / $2,573.94 / $2,632.62	Professional	TC	$2,562.41	$2,573.94	$2,632.62
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $312.83 / $491.51 / $802.54	Professional		$312.83	$491.51	$802.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $105.96 / $134.49 / $326.04	Professional	26	$105.96	$134.49	$326.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $320.01 / $406.16 / $984.64	Professional	TC	$320.01	$406.16	$984.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $96.26 / $299.83 / $873.20	Professional		$96.26	$299.83	$873.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.95 / $96.95 / $96.95	Facility	26	$96.95	$96.95	$96.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $294.54 / $511.51 / $968.14	Professional		$294.54	$511.51	$968.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $70.93 / $102.96 / $177.13	Professional	26	$70.93	$102.96	$177.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $215.82 / $358.60 / $692.14	Professional	TC	$215.82	$358.60	$692.14
United Facility/Professional Professional Modifier Low / Median / High Price $325.75 / $448.65 / $810.97	Professional		$325.75	$448.65	$810.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.34 / $91.67 / $155.93	Professional	26	$73.34	$91.67	$155.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $253.69 / $358.15 / $666.14	Professional	TC	$253.69	$358.15	$666.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $279.66 / $312.83 / $445.08	Professional		$279.66	$312.83	$445.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.56 / $80.22 / $110.67	Professional	26	$69.56	$80.22	$110.67
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $210.09 / $245.54 / $1,400.00	Professional	TC	$210.09	$245.54	$1,400.00