Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.80 / $88.43 / $114.03	Facility	26	$70.80	$88.43	$114.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $226.08 / $316.75 / $624.64	Professional		$226.08	$316.75	$624.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.80 / $88.50 / $158.80	Professional	26	$70.80	$88.50	$158.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.59 / $212.80 / $391.04	Professional	TC	$151.59	$212.80	$391.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $497.85 / $521.16 / $521.16	Professional		$497.85	$521.16	$521.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.48 / $89.60 / $166.97	Professional	26	$66.48	$89.60	$166.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.30 / $211.34 / $307.16	Professional		$70.30	$211.34	$307.16
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $274.52 / $302.94 / $376.00	Professional		$274.52	$302.94	$376.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $80.63 / $80.63 / $86.67	Professional	26	$80.63	$80.63	$86.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.06 / $98.06 / $98.06	Facility	26	$98.06	$98.06	$98.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $255.00 / $410.00 / $808.27	Professional		$255.00	$410.00	$808.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.56 / $97.23 / $178.64	Professional	26	$66.56	$97.23	$178.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $178.50 / $306.83 / $618.55	Professional	TC	$178.50	$306.83	$618.55
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $625.36 / $785.28 / $801.92	Facility	26	$625.36	$785.28	$801.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,101.53 / $3,194.57 / $3,194.57	Professional		$3,101.53	$3,194.57	$3,194.57
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.44 / $660.44 / $691.43	Professional	26	$660.44	$660.44	$691.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,625.91 / $2,704.69 / $2,704.69	Professional	TC	$2,625.91	$2,704.69	$2,704.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $212.47 / $451.73 / $1,204.59	Professional		$212.47	$451.73	$1,204.59
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.65 / $136.63 / $331.24	Professional	26	$107.65	$136.63	$331.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $283.83 / $360.26 / $873.36	Professional	TC	$283.83	$360.26	$873.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $91.16 / $246.50 / $513.79	Professional		$91.16	$246.50	$513.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.06 / $98.06 / $98.06	Facility	26	$98.06	$98.06	$98.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $255.00 / $433.23 / $860.76	Professional		$255.00	$433.23	$860.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.20 / $93.42 / $175.19	Professional	26	$72.20	$93.42	$175.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $178.50 / $287.37 / $618.55	Professional	TC	$178.50	$287.37	$618.55
United Facility/Professional Professional Modifier Low / Median / High Price $278.08 / $394.10 / $693.98	Professional		$278.08	$394.10	$693.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.80 / $92.75 / $165.70	Professional	26	$76.80	$92.75	$165.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $192.99 / $293.75 / $495.50	Professional	TC	$192.99	$293.75	$495.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $222.51 / $249.57 / $354.06	Professional		$222.51	$249.57	$354.06
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.68 / $81.45 / $112.32	Professional	26	$70.68	$81.45	$112.32
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.84 / $177.49 / $1,100.00	Professional	TC	$151.84	$177.49	$1,100.00