Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.36 / $90.84 / $123.82	Facility	26	$69.36	$90.84	$123.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $392.86 / $638.00	Professional		$250.00	$392.86	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.36 / $110.11 / $155.65	Professional	26	$69.36	$110.11	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $274.14 / $440.00	Professional	TC	$187.50	$274.14	$440.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $427.81 / $427.81 / $427.81	Professional		$427.81	$427.81	$427.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $88.85 / $157.51 / $165.58	Professional	26	$88.85	$157.51	$165.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.88 / $219.85 / $335.53	Professional		$69.88	$219.85	$335.53
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $259.27 / $325.04 / $461.52	Professional		$259.27	$325.04	$461.52
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.97 / $79.97 / $85.60	Professional	26	$79.97	$79.97	$85.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.16 / $97.16 / $97.16	Facility	26	$97.16	$97.16	$97.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $232.34 / $431.57 / $913.11	Professional		$232.34	$431.57	$913.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.56 / $100.11 / $183.52	Professional	26	$64.56	$100.11	$183.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.38 / $313.27 / $738.00	Professional	TC	$161.38	$313.27	$738.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $620.48 / $778.96 / $795.36	Facility	26	$620.48	$778.96	$795.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,482.54 / $3,587.02 / $3,587.02	Professional		$3,482.54	$3,587.02	$3,587.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $642.27 / $642.27 / $686.78	Professional	26	$642.27	$642.27	$686.78
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,996.90 / $3,086.80 / $3,086.80	Professional	TC	$2,996.90	$3,086.80	$3,086.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $338.83 / $447.25 / $660.90	Professional		$338.83	$447.25	$660.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.81 / $135.56 / $328.64	Professional	26	$106.81	$135.56	$328.64
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.57 / $311.69 / $755.60	Professional	TC	$245.57	$311.69	$755.60
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $91.03 / $232.05 / $459.10	Professional		$91.03	$232.05	$459.10
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $97.16 / $97.16 / $97.16	Facility	26	$97.16	$97.16	$97.16
Providence Facility/Professional Professional Modifier Low / Median / High Price $241.91 / $482.34 / $894.53	Professional		$241.91	$482.34	$894.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $70.42 / $94.83 / $177.60	Professional	26	$70.42	$94.83	$177.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $161.38 / $313.27 / $740.23	Professional	TC	$161.38	$313.27	$740.23
United Facility/Professional Professional Modifier Low / Median / High Price $256.38 / $390.86 / $801.76	Professional		$256.38	$390.86	$801.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.08 / $91.67 / $174.17	Professional	26	$76.08	$91.67	$174.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.49 / $297.45 / $593.37	Professional	TC	$194.49	$297.45	$593.37
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $231.34 / $259.27 / $368.06	Professional		$231.34	$259.27	$368.06
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.12 / $80.77 / $111.44	Professional	26	$70.12	$80.77	$111.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $161.22 / $188.43 / $1,400.00	Professional	TC	$161.22	$188.43	$1,400.00