Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.50 / $130.96 / $135.81	Facility	26	$83.50	$130.96	$135.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $344.12 / $487.90 / $743.70	Professional		$344.12	$487.90	$743.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.50 / $135.04 / $254.90	Professional	26	$83.50	$135.04	$254.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $260.62 / $359.94 / $568.59	Professional	TC	$260.62	$359.94	$568.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $252.99 / $361.41 / $596.33	Professional		$252.99	$361.41	$596.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.61 / $136.74 / $198.87	Professional	26	$77.61	$136.74	$198.87
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $370.16 / $370.16 / $370.16	Professional	TC	$370.16	$370.16	$370.16
BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.34 / $284.06 / $468.48	Professional		$85.34	$284.06	$468.48
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $361.41 / $451.76 / $722.82	Professional		$361.41	$451.76	$722.82
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $96.04 / $101.93 / $247.99	Professional	26	$96.04	$101.93	$247.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.87 / $116.87 / $116.87	Facility	26	$116.87	$116.87	$116.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $324.98 / $562.83 / $1,286.43	Professional		$324.98	$562.83	$1,286.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.84 / $121.51 / $212.97	Professional	26	$79.84	$121.51	$212.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.25 / $430.80 / $1,041.68	Professional	TC	$239.25	$430.80	$1,041.68
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $745.12 / $935.44 / $957.12	Facility	26	$745.12	$935.44	$957.12
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 $883.52 / $894.00 / $894.00	Professional	26	$883.52	$894.00	$894.00
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 $382.32 / $654.15 / $1,513.80	Professional		$382.32	$654.15	$1,513.80
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 $363.74 / $461.67 / $1,119.20	Professional	TC	$363.74	$461.67	$1,119.20
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $110.76 / $349.36 / $707.27	Professional		$110.76	$349.36	$707.27
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.87 / $116.87 / $116.87	Facility	26	$116.87	$116.87	$116.87
Providence Facility/Professional Professional Modifier Low / Median / High Price $341.81 / $600.00 / $1,227.08	Professional		$341.81	$600.00	$1,227.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $85.74 / $121.51 / $205.68	Professional	26	$85.74	$121.51	$205.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $247.72 / $410.39 / $984.26	Professional	TC	$247.72	$410.39	$984.26
United Facility/Professional Professional Modifier Low / Median / High Price $388.36 / $538.41 / $1,110.61	Professional		$388.36	$538.41	$1,110.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.29 / $109.71 / $207.88	Professional	26	$87.29	$109.71	$207.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.93 / $445.42 / $872.19	Professional	TC	$296.93	$445.42	$872.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $323.00 / $361.41 / $514.01	Professional		$323.00	$361.41	$514.01
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 $238.80 / $279.14 / $1,400.00	Professional	TC	$238.80	$279.14	$1,400.00