Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.01 / $157.97 / $188.71	Facility	26	$100.01	$157.97	$188.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $340.31 / $475.00 / $696.86	Professional		$340.31	$475.00	$696.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.01 / $149.33 / $386.40	Professional	26	$100.01	$149.33	$386.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.67 / $335.00 / $487.18	Professional	TC	$223.67	$335.00	$487.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.16 / $339.90 / $347.49	Professional		$251.16	$339.90	$347.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $92.68 / $118.40 / $213.03	Professional	26	$92.68	$118.40	$213.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.05 / $280.89 / $469.15	Professional		$109.05	$280.89	$469.15
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $339.90 / $440.64 / $562.41	Professional		$339.90	$440.64	$562.41
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $114.67 / $121.18 / $122.49	Professional	26	$114.67	$121.18	$122.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $304.98 / $514.67 / $997.29	Professional		$304.98	$514.67	$997.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.59 / $138.50 / $251.05	Professional	26	$94.59	$138.50	$251.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.20 / $366.50 / $764.98	Professional	TC	$203.20	$366.50	$764.98
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $888.48 / $1,118.24 / $1,142.00	Facility	26	$888.48	$1,118.24	$1,142.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,919.13 / $4,036.70 / $4,036.70	Professional		$3,919.13	$4,036.70	$4,036.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $771.93 / $771.93 / $980.18	Professional	26	$771.93	$771.93	$980.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,292.02 / $3,390.79 / $3,390.79	Professional	TC	$3,292.02	$3,390.79	$3,390.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $339.90 / $585.49 / $934.05	Professional		$339.90	$585.49	$934.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $153.06 / $194.27 / $470.96	Professional	26	$153.06	$194.27	$470.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $308.23 / $391.22 / $948.40	Professional	TC	$308.23	$391.22	$948.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $143.62 / $315.56 / $571.25	Professional		$143.62	$315.56	$571.25
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $321.60 / $552.72 / $1,059.92	Professional		$321.60	$552.72	$1,059.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $102.01 / $138.00 / $250.14	Professional	26	$102.01	$138.00	$250.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $210.09 / $354.22 / $755.74	Professional	TC	$210.09	$354.22	$755.74
United Facility/Professional Professional Modifier Low / Median / High Price $361.96 / $511.90 / $946.16	Professional		$361.96	$511.90	$946.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.22 / $130.28 / $246.85	Professional	26	$104.22	$130.28	$246.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.46 / $355.56 / $699.60	Professional	TC	$245.46	$355.56	$699.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $302.85 / $339.90 / $481.99	Professional		$302.85	$339.90	$481.99
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $100.49 / $115.85 / $159.84	Professional	26	$100.49	$115.85	$159.84
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $202.36 / $236.53 / $1,400.00	Professional	TC	$202.36	$236.53	$1,400.00