Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.12 / $104.40 / $126.65	Facility	26	$67.12	$104.40	$126.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $266.85 / $418.78 / $638.00	Professional		$266.85	$418.78	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.12 / $106.60 / $154.00	Professional	26	$67.12	$106.60	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.73 / $312.18 / $480.00	Professional	TC	$199.73	$312.18	$480.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.77 / $198.77 / $227.16	Professional		$198.77	$198.77	$227.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.67 / $77.33 / $132.83	Professional	26	$65.67	$77.33	$132.83
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $144.63 / $144.63 / $144.63	Professional	TC	$144.63	$144.63	$144.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $71.15 / $257.64 / $367.30	Professional		$71.15	$257.64	$367.30
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $283.95 / $312.35 / $378.00	Professional		$283.95	$312.35	$378.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $76.54 / $76.54 / $82.86	Professional	26	$76.54	$76.54	$82.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $255.18 / $473.53 / $942.32	Professional		$255.18	$473.53	$942.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.23 / $97.72 / $172.87	Professional	26	$64.23	$97.72	$172.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.96 / $362.53 / $775.96	Professional	TC	$186.96	$362.53	$775.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $593.12 / $746.48 / $764.32	Facility	26	$593.12	$746.48	$764.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,392.38 / $3,491.47 / $3,491.47	Professional		$3,392.38	$3,491.47	$3,491.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $667.05 / $667.05 / $667.05	Professional	26	$667.05	$667.05	$667.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,981.99 / $3,042.45 / $3,063.70	Professional	TC	$2,981.99	$3,042.45	$3,063.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $371.58 / $490.48 / $728.68	Professional		$371.58	$490.48	$728.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.18 / $129.69 / $314.39	Professional	26	$102.18	$129.69	$314.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $284.26 / $360.79 / $874.64	Professional	TC	$284.26	$360.79	$874.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $87.08 / $264.08 / $547.00	Professional		$87.08	$264.08	$547.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $272.51 / $510.00 / $953.83	Professional		$272.51	$510.00	$953.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $68.43 / $97.99 / $170.69	Professional	26	$68.43	$97.99	$170.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $195.62 / $350.00 / $775.17	Professional	TC	$195.62	$350.00	$775.17
United Facility/Professional Professional Modifier Low / Median / High Price $303.70 / $464.48 / $856.43	Professional		$303.70	$464.48	$856.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.54 / $88.78 / $168.68	Professional	26	$70.54	$88.78	$168.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.26 / $368.42 / $600.88	Professional	TC	$226.26	$368.42	$600.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $253.70 / $283.95 / $403.80	Professional		$253.70	$283.95	$403.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.08 / $77.33 / $106.70	Professional	26	$67.08	$77.33	$106.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $186.62 / $218.13 / $1,400.00	Professional	TC	$186.62	$218.13	$1,400.00