Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.22 / $132.00 / $154.85	Facility	26	$83.22	$132.00	$154.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $297.56 / $475.00 / $921.46	Professional		$297.56	$475.00	$921.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.22 / $135.81 / $328.98	Professional	26	$83.22	$135.81	$328.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.34 / $335.00 / $499.00	Professional	TC	$214.34	$335.00	$499.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $221.96 / $268.22 / $523.20	Professional		$221.96	$268.22	$523.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.61 / $106.71 / $189.18	Professional	26	$77.61	$106.71	$189.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.48 / $253.42 / $405.90	Professional		$83.48	$253.42	$405.90
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $317.08 / $475.64 / $634.17	Professional		$317.08	$475.64	$634.17
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $96.04 / $101.60 / $184.48	Professional	26	$96.04	$101.60	$184.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $284.99 / $541.79 / $1,285.81	Professional		$284.99	$541.79	$1,285.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.56 / $115.92 / $212.28	Professional	26	$77.56	$115.92	$212.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $198.89 / $410.30 / $1,041.68	Professional	TC	$198.89	$410.30	$1,041.68
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $745.12 / $935.44 / $950.80	Facility	26	$745.12	$935.44	$950.80
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,978.92 / $6,158.29 / $6,158.29	Professional		$5,978.92	$6,158.29	$6,158.29
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $733.09 / $733.09 / $824.33	Professional	26	$733.09	$733.09	$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 $253.50 / $547.05 / $877.50	Professional		$253.50	$547.05	$877.50
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 $302.76 / $384.27 / $931.56	Professional	TC	$302.76	$384.27	$931.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $109.03 / $281.27 / $605.86	Professional		$109.03	$281.27	$605.86
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $296.05 / $608.80 / $1,114.50	Professional		$296.05	$608.80	$1,114.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $84.13 / $109.83 / $206.30	Professional	26	$84.13	$109.83	$206.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $199.09 / $392.95 / $1,040.15	Professional	TC	$199.09	$392.95	$1,040.15
United Facility/Professional Professional Modifier Low / Median / High Price $336.82 / $520.51 / $1,041.02	Professional		$336.82	$520.51	$1,041.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.18 / $109.28 / $185.90	Professional	26	$87.18	$109.28	$185.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $243.87 / $395.99 / $776.38	Professional	TC	$243.87	$395.99	$776.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $282.97 / $317.08 / $450.25	Professional		$282.97	$317.08	$450.25
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 $198.76 / $232.34 / $1,400.00	Professional	TC	$198.76	$232.34	$1,400.00