Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $117.37 / $151.41	Facility	26	$94.06	$117.37	$151.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $185.39 / $247.94 / $380.51	Professional		$185.39	$247.94	$380.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $114.96 / $176.08	Professional	26	$86.00	$114.96	$176.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.53 / $119.70 / $220.00	Professional	TC	$93.53	$119.70	$220.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $326.14 / $326.14 / $326.14	Professional		$326.14	$326.14	$326.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $86.52 / $86.52 / $106.76	Professional	26	$86.52	$86.52	$106.76
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $222.52 / $222.52 / $222.52	Professional	TC	$222.52	$222.52	$222.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.60 / $201.61 / $303.57	Professional		$143.60	$201.61	$303.57
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $240.03 / $347.68 / $449.66	Professional		$240.03	$347.68	$449.66
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $107.07 / $107.07 / $114.98	Professional	26	$107.07	$107.07	$114.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.66 / $129.66 / $129.66	Facility	26	$129.66	$129.66	$129.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $290.00 / $462.09 / $916.74	Professional		$290.00	$462.09	$916.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.23 / $120.55 / $225.55	Professional	26	$79.23	$120.55	$225.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.35 / $349.09 / $700.06	Professional	TC	$208.35	$349.09	$700.06
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $830.40 / $1,043.04 / $1,061.59	Facility	26	$830.40	$1,043.04	$1,061.59
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,850.25 / $1,915.39 / $1,992.01	Professional		$1,850.25	$1,915.39	$1,992.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $717.76 / $717.76 / $918.38	Professional	26	$717.76	$717.76	$918.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,344.20 / $1,435.54 / $1,492.96	Professional	TC	$1,344.20	$1,435.54	$1,492.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $377.78 / $606.50 / $1,007.36	Professional		$377.78	$606.50	$1,007.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $142.97 / $181.47 / $439.92	Professional	26	$142.97	$181.47	$439.92
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $382.66 / $485.68 / $1,177.40	Professional	TC	$382.66	$485.68	$1,177.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $561.10 / $1,015.90 / $1,224.09	Professional		$561.10	$1,015.90	$1,224.09
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $129.66 / $129.66 / $129.66	Facility	26	$129.66	$129.66	$129.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $293.00 / $508.60 / $1,140.07	Professional		$293.00	$508.60	$1,140.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $75.00 / $116.16 / $215.32	Professional	26	$75.00	$116.16	$215.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $196.30 / $339.97 / $691.34	Professional	TC	$196.30	$339.97	$691.34
United Facility/Professional Professional Modifier Low / Median / High Price $363.33 / $485.04 / $824.57	Professional		$363.33	$485.04	$824.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $98.16 / $122.70 / $208.59	Professional	26	$98.16	$122.70	$208.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $264.76 / $363.60 / $615.98	Professional	TC	$264.76	$363.60	$615.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $184.69 / $208.72 / $293.80	Professional		$184.69	$208.72	$293.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $93.86 / $108.15 / $149.19	Professional	26	$93.86	$108.15	$149.19
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $90.83 / $106.18 / $1,100.00	Professional	TC	$90.83	$106.18	$1,100.00