Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.48 / $83.15 / $119.83	Facility	26	$63.48	$83.15	$119.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $278.08 / $447.61 / $782.99	Professional		$278.08	$447.61	$782.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.48 / $111.15 / $180.15	Professional	26	$63.48	$111.15	$180.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.60 / $335.00 / $480.00	Professional	TC	$214.60	$335.00	$480.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $233.75 / $291.70 / $522.89	Professional		$233.75	$291.70	$522.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.29 / $102.32 / $142.07	Professional	26	$58.29	$102.32	$142.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $175.08 / $175.08 / $175.08	Professional	TC	$175.08	$175.08	$175.08
BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.16 / $242.64 / $383.50	Professional		$63.16	$242.64	$383.50
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $291.70 / $356.00 / $553.67	Professional		$291.70	$356.00	$553.67
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $72.12 / $72.12 / $78.34	Professional	26	$72.12	$72.12	$78.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.30 / $88.30 / $88.30	Facility	26	$88.30	$88.30	$88.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $262.80 / $454.14 / $875.34	Professional		$262.80	$454.14	$875.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.71 / $91.53 / $163.15	Professional	26	$60.71	$91.53	$163.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $198.03 / $355.30 / $715.31	Professional	TC	$198.03	$355.30	$715.31
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $558.79 / $703.76 / $723.52	Facility	26	$558.79	$703.76	$723.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,348.15 / $3,448.60 / $3,448.60	Professional		$3,348.15	$3,448.60	$3,448.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $586.14 / $586.14 / $616.42	Professional	26	$586.14	$586.14	$616.42
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,941.88 / $3,030.13 / $3,030.13	Professional	TC	$2,941.88	$3,030.13	$3,030.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $291.70 / $528.00 / $1,214.67	Professional		$291.70	$528.00	$1,214.67
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.29 / $122.22 / $296.27	Professional	26	$96.29	$122.22	$296.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $301.08 / $382.14 / $926.40	Professional	TC	$301.08	$382.14	$926.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.51 / $281.25 / $569.49	Professional		$82.51	$281.25	$569.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $88.30 / $88.30 / $88.30	Facility	26	$88.30	$88.30	$88.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $276.39 / $483.84 / $915.59	Professional		$276.39	$483.84	$915.59
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.42 / $92.21 / $162.00	Professional	26	$64.42	$92.21	$162.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $204.95 / $342.60 / $696.61	Professional	TC	$204.95	$342.60	$696.61
United Facility/Professional Professional Modifier Low / Median / High Price $315.24 / $445.63 / $804.91	Professional		$315.24	$445.63	$804.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.03 / $83.73 / $159.09	Professional	26	$66.03	$83.73	$159.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $244.49 / $345.15 / $647.16	Professional	TC	$244.49	$345.15	$647.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $260.88 / $291.70 / $415.26	Professional		$260.88	$291.70	$415.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $63.22 / $72.86 / $100.59	Professional	26	$63.22	$72.86	$100.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $197.66 / $231.04 / $1,400.00	Professional	TC	$197.66	$231.04	$1,400.00