Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.56 / $106.87 / $138.08	Facility	26	$85.56	$106.87	$138.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $336.68 / $443.27 / $837.86	Professional		$336.68	$443.27	$837.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.56 / $109.68 / $356.04	Professional	26	$85.56	$109.68	$356.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.12 / $322.79 / $532.20	Professional	TC	$251.12	$322.79	$532.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $302.70 / $378.39 / $589.91	Professional		$302.70	$378.39	$589.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.56 / $108.49 / $192.32	Professional	26	$78.56	$108.49	$192.32
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $220.06 / $220.06 / $220.06	Professional	TC	$220.06	$220.06	$220.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $84.85 / $280.66 / $421.98	Professional		$84.85	$280.66	$421.98
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $325.00 / $489.37 / $697.16	Professional		$325.00	$489.37	$697.16
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $94.82 / $97.63 / $103.42	Professional	26	$94.82	$97.63	$103.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.52 / $118.52 / $118.52	Facility	26	$118.52	$118.52	$118.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $278.83 / $484.78 / $933.99	Professional		$278.83	$484.78	$933.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.50 / $114.29 / $212.20	Professional	26	$76.50	$114.29	$212.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.83 / $371.18 / $754.89	Professional	TC	$203.83	$371.18	$754.89
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $757.60 / $950.32 / $969.20	Facility	26	$757.60	$950.32	$969.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,573.48 / $2,573.48 / $3,239.10	Professional		$2,573.48	$2,573.48	$3,239.10
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $653.20 / $653.20 / $838.43	Professional	26	$653.20	$653.20	$838.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,038.19 / $2,099.33 / $2,400.67	Professional	TC	$2,038.19	$2,099.33	$2,400.67
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $172.14 / $561.38 / $967.64	Professional		$172.14	$561.38	$967.64
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $130.35 / $165.45 / $401.08	Professional	26	$130.35	$165.45	$401.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $356.16 / $452.05 / $1,095.88	Professional	TC	$356.16	$452.05	$1,095.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $112.29 / $330.42 / $625.66	Professional		$112.29	$330.42	$625.66
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $118.52 / $118.52 / $118.52	Facility	26	$118.52	$118.52	$118.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $290.00 / $517.64 / $1,071.91	Professional		$290.00	$517.64	$1,071.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $76.50 / $108.22 / $205.54	Professional	26	$76.50	$108.22	$205.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $194.17 / $357.92 / $754.89	Professional	TC	$194.17	$357.92	$754.89
United Facility/Professional Professional Modifier Low / Median / High Price $329.14 / $478.49 / $779.56	Professional		$329.14	$478.49	$779.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.51 / $111.88 / $197.79	Professional	26	$89.51	$111.88	$197.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.67 / $361.31 / $599.08	Professional	TC	$251.67	$361.31	$599.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $319.41 / $357.52 / $508.19	Professional		$319.41	$357.52	$508.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.58 / $98.63 / $135.96	Professional	26	$85.58	$98.63	$135.96
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $233.83 / $273.30 / $1,100.00	Professional	TC	$233.83	$273.30	$1,100.00