Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.60 / $60.83 / $108.16	Facility	26	$55.60	$60.83	$108.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.67 / $456.86 / $1,247.66	Professional		$316.67	$456.86	$1,247.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.60 / $79.92 / $196.19	Professional	26	$55.60	$79.92	$196.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.77 / $365.69 / $679.76	Professional	TC	$257.77	$365.69	$679.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $284.79 / $430.64 / $569.58	Professional		$284.79	$430.64	$569.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.42 / $86.42 / $135.47	Professional	26	$78.42	$86.42	$135.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.59 / $339.58 / $509.53	Professional		$73.59	$339.58	$509.53
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $406.84 / $488.21 / $669.34	Professional		$406.84	$488.21	$669.34
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $77.84 / $83.08 / $83.08	Professional	26	$77.84	$83.08	$83.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $382.75 / $516.65 / $988.92	Professional		$382.75	$516.65	$988.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.73 / $94.07 / $157.78	Professional	26	$69.73	$94.07	$157.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $317.75 / $426.13 / $822.74	Professional	TC	$317.75	$426.13	$822.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $192.44 / $1,357.70 / $1,357.70	Facility	26	$192.44	$1,357.70	$1,357.70
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,499.00 / $4,499.00 / $4,499.00	Professional		$4,499.00	$4,499.00	$4,499.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,350.00 / $1,350.00 / $1,350.00	Professional	26	$1,350.00	$1,350.00	$1,350.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,149.00 / $3,149.00 / $3,149.00	Professional	TC	$3,149.00	$3,149.00	$3,149.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $115.42 / $565.96 / $900.00	Professional		$115.42	$565.96	$900.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.29 / $132.36 / $183.50	Professional	26	$104.29	$132.36	$183.50
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $451.62 / $573.21 / $848.98	Professional	TC	$451.62	$573.21	$848.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $96.88 / $436.60 / $746.21	Professional		$96.88	$436.60	$746.21
Providence Facility/Professional Professional Modifier Low / Median / High Price $397.61 / $517.57 / $994.47	Professional		$397.61	$517.57	$994.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $70.62 / $94.07 / $159.91	Professional	26	$70.62	$94.07	$159.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $327.20 / $426.13 / $840.98	Professional	TC	$327.20	$426.13	$840.98
United Facility/Professional Professional Modifier Low / Median / High Price $431.92 / $576.97 / $807.83	Professional		$431.92	$576.97	$807.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.14 / $92.37 / $133.79	Professional	26	$68.14	$92.37	$133.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $354.54 / $486.41 / $701.76	Professional	TC	$354.54	$486.41	$701.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $364.96 / $406.84 / $581.09	Professional		$364.96	$406.84	$581.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $68.47 / $78.56 / $108.99	Professional	26	$68.47	$78.56	$108.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $296.50 / $328.28 / $472.11	Professional	TC	$296.50	$328.28	$472.11