Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.90 / $134.63 / $157.97	Facility	26	$84.90	$134.63	$157.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $298.11 / $475.00 / $859.53	Professional		$298.11	$475.00	$859.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.90 / $140.00 / $380.80	Professional	26	$84.90	$140.00	$380.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.21 / $335.00 / $589.50	Professional	TC	$213.21	$335.00	$589.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $254.48 / $270.38 / $524.85	Professional		$254.48	$270.38	$524.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.47 / $101.08 / $192.93	Professional	26	$78.47	$101.08	$192.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $175.33 / $306.82 / $603.66	Professional	TC	$175.33	$306.82	$603.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.13 / $261.72 / $404.71	Professional		$85.13	$261.72	$404.71
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $318.08 / $477.14 / $800.00	Professional		$318.08	$477.14	$800.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $97.94 / $104.08 / $202.61	Professional	26	$97.94	$104.08	$202.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $285.83 / $529.66 / $1,292.31	Professional		$285.83	$529.66	$1,292.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.24 / $127.05 / $219.45	Professional	26	$83.24	$127.05	$219.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $198.31 / $385.00 / $1,036.57	Professional	TC	$198.31	$385.00	$1,036.57
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $759.68 / $954.08 / $973.04	Facility	26	$759.68	$954.08	$973.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,025.38 / $6,206.15 / $6,206.15	Professional		$6,025.38	$6,206.15	$6,206.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $891.52 / $891.52 / $891.52	Professional	26	$891.52	$891.52	$891.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,457.89 / $5,621.63 / $5,621.63	Professional	TC	$5,457.89	$5,621.63	$5,621.63
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $181.88 / $498.78 / $1,425.00	Professional		$181.88	$498.78	$1,425.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $130.78 / $165.99 / $402.40	Professional	26	$130.78	$165.99	$402.40
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $301.50 / $382.67 / $927.68	Professional	TC	$301.50	$382.67	$927.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $111.62 / $288.85 / $613.79	Professional		$111.62	$288.85	$613.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $309.51 / $587.78 / $1,118.48	Professional		$309.51	$587.78	$1,118.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.46 / $127.77 / $215.17	Professional	26	$87.46	$127.77	$215.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $208.08 / $370.43 / $983.94	Professional	TC	$208.08	$370.43	$983.94
United Facility/Professional Professional Modifier Low / Median / High Price $337.75 / $524.79 / $1,063.44	Professional		$337.75	$524.79	$1,063.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.50 / $111.88 / $212.58	Professional	26	$89.50	$111.88	$212.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $242.65 / $394.20 / $772.48	Professional	TC	$242.65	$394.20	$772.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $283.80 / $318.08 / $451.58	Professional		$283.80	$318.08	$451.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.86 / $98.94 / $136.46	Professional	26	$85.86	$98.94	$136.46
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $197.94 / $231.37 / $1,400.00	Professional	TC	$197.94	$231.37	$1,400.00