Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.34 / $90.91 / $123.82	Facility	26	$69.34	$90.91	$123.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $294.07 / $461.61 / $791.25	Professional		$294.07	$461.61	$791.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.34 / $110.11 / $149.06	Professional	26	$69.34	$110.11	$149.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $224.71 / $335.00 / $490.25	Professional	TC	$224.71	$335.00	$490.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $157.65 / $157.65 / $157.65	Professional	26	$157.65	$157.65	$157.65
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $379.81 / $379.81 / $379.81	Professional	50	$379.81	$379.81	$379.81
BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.98 / $253.05 / $411.47	Professional		$82.98	$253.05	$411.47
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $296.25 / $296.25 / $506.40	Professional		$296.25	$296.25	$506.40
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $80.02 / $80.02 / $86.00	Professional	26	$80.02	$80.02	$86.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.37 / $97.37 / $97.37	Facility	26	$97.37	$97.37	$97.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $284.77 / $490.60 / $873.20	Professional		$284.77	$490.60	$873.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.44 / $102.95 / $184.08	Professional	26	$66.44	$102.95	$184.08
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $507.23 / $507.23 / $616.05	Professional	50	$507.23	$507.23	$616.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.07 / $374.50 / $714.59	Professional	TC	$213.07	$374.50	$714.59
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $620.48 / $779.12 / $795.52	Facility	26	$620.48	$779.12	$795.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,018.44 / $3,045.40 / $3,045.40	Professional		$3,018.44	$3,045.40	$3,045.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $850.86 / $850.86 / $850.86	Professional	26	$850.86	$850.86	$850.86
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,546.60 / $2,573.94 / $2,616.37	Professional	TC	$2,546.60	$2,573.94	$2,616.37
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $403.65 / $547.05 / $803.31	Professional		$403.65	$547.05	$803.31
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 50 Low / Median / High Price $826.47 / $826.47 / $826.47	Professional	50	$826.47	$826.47	$826.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $324.20 / $411.49 / $997.56	Professional	TC	$324.20	$411.49	$997.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $91.04 / $300.73 / $610.60	Professional		$91.04	$300.73	$610.60
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $97.37 / $97.37 / $97.37	Facility	26	$97.37	$97.37	$97.37
Providence Facility/Professional Professional Modifier Low / Median / High Price $296.25 / $514.11 / $971.29	Professional		$296.25	$514.11	$971.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.64 / $103.08 / $177.16	Professional	26	$71.64	$103.08	$177.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $216.36 / $361.21 / $704.41	Professional	TC	$216.36	$361.21	$704.41
United Facility/Professional Professional Modifier Low / Median / High Price $333.75 / $460.98 / $807.10	Professional		$333.75	$460.98	$807.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.73 / $92.03 / $159.32	Professional	26	$73.73	$92.03	$159.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $253.15 / $349.32 / $601.24	Professional	TC	$253.15	$349.32	$601.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $282.97 / $316.50 / $450.25	Professional		$282.97	$316.50	$450.25
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.12 / $80.84 / $111.44	Professional	26	$70.12	$80.84	$111.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $212.85 / $248.77 / $1,400.00	Professional	TC	$212.85	$248.77	$1,400.00