Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.34 / $116.36 / $164.37	Facility	26	$93.34	$116.36	$164.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.64 / $330.19 / $572.85	Professional		$242.64	$330.19	$572.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.34 / $116.36 / $234.69	Professional	26	$93.34	$116.36	$234.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.29 / $213.56 / $350.04	Professional	TC	$149.29	$213.56	$350.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.50 / $259.25 / $542.32	Professional		$213.50	$259.25	$542.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $85.79 / $128.69 / $209.12	Professional	26	$85.79	$128.69	$209.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $158.21 / $158.21 / $168.09	Professional	TC	$158.21	$158.21	$168.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.27 / $221.64 / $351.33	Professional		$92.27	$221.64	$351.33
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $320.16 / $457.50 / $576.29	Professional		$320.16	$457.50	$576.29
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $106.15 / $113.05 / $118.25	Professional	26	$106.15	$113.05	$118.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.94 / $128.94 / $128.94	Facility	26	$128.94	$128.94	$128.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $255.00 / $423.16 / $861.23	Professional		$255.00	$423.16	$861.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.44 / $121.52 / $229.64	Professional	26	$81.44	$121.52	$229.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $178.50 / $299.72 / $645.80	Professional	TC	$178.50	$299.72	$645.80
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $822.80 / $1,034.56 / $1,056.00	Facility	26	$822.80	$1,034.56	$1,056.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,091.94 / $2,091.94 / $2,743.65	Professional		$2,091.94	$2,091.94	$2,743.65
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $711.82 / $711.82 / $908.70	Professional	26	$711.82	$711.82	$908.70
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,773.11 / $1,773.11 / $1,834.95	Professional	TC	$1,773.11	$1,773.11	$1,834.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $198.60 / $477.44 / $1,359.46	Professional		$198.60	$477.44	$1,359.46
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.71 / $179.87 / $436.04	Professional	26	$141.71	$179.87	$436.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $272.06 / $345.31 / $837.12	Professional	TC	$272.06	$345.31	$837.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $127.25 / $288.73 / $586.54	Professional		$127.25	$288.73	$586.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $128.94 / $128.94 / $128.94	Facility	26	$128.94	$128.94	$128.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $273.87 / $472.29 / $913.56	Professional		$273.87	$472.29	$913.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.70 / $117.39 / $220.89	Professional	26	$79.70	$117.39	$220.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $178.50 / $287.73 / $649.83	Professional	TC	$178.50	$287.73	$649.83
United Facility/Professional Professional Modifier Low / Median / High Price $316.33 / $438.71 / $766.05	Professional		$316.33	$438.71	$766.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $96.64 / $120.90 / $205.53	Professional	26	$96.64	$120.90	$205.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $212.88 / $308.51 / $575.59	Professional	TC	$212.88	$308.51	$575.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $271.64 / $305.00 / $432.22	Professional		$271.64	$305.00	$432.22
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $93.04 / $107.24 / $147.93	Professional	26	$93.04	$107.24	$147.93
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $178.61 / $208.74 / $1,100.00	Professional	TC	$178.61	$208.74	$1,100.00