Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.50 / $132.30 / $155.35	Facility	26	$83.50	$132.30	$155.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $364.32 / $504.26 / $852.89	Professional		$364.32	$504.26	$852.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.50 / $132.44 / $291.11	Professional	26	$83.50	$132.44	$291.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $280.81 / $375.20 / $612.66	Professional	TC	$280.81	$375.20	$612.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $324.32 / $487.37 / $633.14	Professional		$324.32	$487.37	$633.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.61 / $106.70 / $189.18	Professional	26	$77.61	$106.70	$189.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.19 / $300.87 / $491.77	Professional		$87.19	$300.87	$491.77
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $364.53 / $422.09 / $728.08	Professional		$364.53	$422.09	$728.08
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $96.04 / $96.04 / $103.05	Professional	26	$96.04	$96.04	$103.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Facility	26	$116.52	$116.52	$116.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $345.22 / $581.49 / $1,287.16	Professional		$345.22	$581.49	$1,287.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.84 / $121.13 / $212.28	Professional	26	$79.84	$121.13	$212.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $259.12 / $464.58 / $1,049.23	Professional	TC	$259.12	$464.58	$1,049.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $745.12 / $935.44 / $953.92	Facility	26	$745.12	$935.44	$953.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,981.06 / $6,160.49 / $6,160.49	Professional		$5,981.06	$6,160.49	$6,160.49
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $672.78 / $672.78 / $824.33	Professional	26	$672.78	$672.78	$824.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,438.76 / $5,601.93 / $5,601.93	Professional	TC	$5,438.76	$5,601.93	$5,601.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $231.73 / $663.42 / $1,608.28	Professional		$231.73	$663.42	$1,608.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.26 / $162.79 / $394.64	Professional	26	$128.26	$162.79	$394.64
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $394.43 / $500.63 / $1,213.64	Professional	TC	$394.43	$500.63	$1,213.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $110.76 / $370.78 / $751.73	Professional		$110.76	$370.78	$751.73
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Facility	26	$116.52	$116.52	$116.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $361.63 / $632.32 / $1,267.11	Professional		$361.63	$632.32	$1,267.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $85.74 / $121.55 / $206.30	Professional	26	$85.74	$121.55	$206.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $267.44 / $442.21 / $1,040.15	Professional	TC	$267.44	$442.21	$1,040.15
United Facility/Professional Professional Modifier Low / Median / High Price $413.52 / $593.32 / $1,141.54	Professional		$413.52	$593.32	$1,141.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.61 / $109.71 / $194.41	Professional	26	$87.61	$109.71	$194.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $304.52 / $452.14 / $933.96	Professional	TC	$304.52	$452.14	$933.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $343.15 / $383.72 / $546.05	Professional		$343.15	$383.72	$546.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $84.20 / $97.01 / $133.81	Professional	26	$84.20	$97.01	$133.81
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $258.95 / $302.68 / $1,400.00	Professional	TC	$258.95	$302.68	$1,400.00