Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $158.49 / $208.93	Facility	26	$125.89	$158.49	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $501.19 / $1,202.26	Professional		$354.81	$501.19	$1,202.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $181.97 / $478.63	Professional	26	$102.33	$181.97	$478.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $346.74 / $562.34	Professional	TC	$223.87	$346.74	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $338.84	Professional		$302.00	$302.00	$338.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $141.25 / $199.53	Professional	26	$93.33	$141.25	$199.53
BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $288.40 / $416.87	Professional		$95.50	$288.40	$416.87
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $426.58 / $562.34	Professional		$338.84	$426.58	$562.34
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $120.23 / $123.03	Professional	26	$114.82	$120.23	$123.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $138.04 / $199.53	Facility	26	$30.20	$138.04	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $512.86 / $1,071.52	Professional		$331.13	$512.86	$1,071.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $141.25 / $263.03	Professional	26	$102.33	$141.25	$263.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $371.54 / $794.33	Professional	TC	$234.42	$371.54	$794.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,122.02 / $1,122.02 / $1,122.02	Facility	26	$1,122.02	$1,122.02	$1,122.02
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,073.80 / $4,073.80 / $4,073.80	Professional		$4,073.80	$4,073.80	$4,073.80
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $776.25 / $977.24 / $977.24	Professional	26	$776.25	$977.24	$977.24
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Professional	TC	$3,388.44	$3,388.44	$3,388.44
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $158.49 / $208.93	Facility	26	$100.00	$158.49	$208.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $537.03 / $1,122.02	Professional		$371.54	$537.03	$1,122.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $181.97 / $407.38	Professional	26	$112.20	$181.97	$407.38
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $371.54 / $691.83	Professional	TC	$251.19	$371.54	$691.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $302.00	Professional		$32.36	$33.11	$302.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $1,000.00 / $1,148.15	Professional		$660.69	$1,000.00	$1,148.15
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $138.04 / $199.53	Facility	26	$30.20	$138.04	$199.53
Providence Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $512.86 / $1,047.13	Professional		$338.84	$512.86	$1,047.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $138.04 / $239.88	Professional	26	$102.33	$138.04	$239.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $354.81 / $758.58	Professional	TC	$223.87	$354.81	$758.58
United Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $512.86 / $933.25	Professional		$363.08	$512.86	$933.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $128.82 / $245.47	Professional	26	$104.71	$128.82	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $354.81 / $676.08	Professional	TC	$251.19	$354.81	$676.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $363.08 / $436.52	Professional		$346.74	$363.08	$436.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $123.03 / $147.91	Professional	26	$117.49	$123.03	$147.91
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $234.42 / $288.40	Professional	TC	$234.42	$234.42	$288.40