Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.55 / $71.59 / $135.58	Facility	26	$70.55	$71.59	$135.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.31 / $410.26 / $787.01	Professional		$288.31	$410.26	$787.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.05 / $95.92 / $231.29	Professional	26	$71.05	$95.92	$231.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.56 / $302.52 / $489.68	Professional	TC	$214.56	$302.52	$489.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $260.94 / $372.78 / $521.89	Professional		$260.94	$372.78	$521.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.34 / $120.52 / $141.05	Professional	26	$80.34	$120.52	$141.05
BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $335.20 / $476.31	Professional		$85.11	$335.20	$476.31
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $372.78 / $447.34 / $612.19	Professional		$372.78	$447.34	$612.19
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $99.53 / $106.55 / $106.55	Professional	26	$99.53	$106.55	$106.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $348.85 / $466.76 / $846.13	Professional		$348.85	$466.76	$846.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.11 / $120.15 / $200.95	Professional	26	$89.11	$120.15	$200.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $259.74 / $360.02 / $645.17	Professional	TC	$259.74	$360.02	$645.17
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $246.31 / $529.44 / $529.44	Facility	26	$246.31	$529.44	$529.44
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,670.75 / $2,670.75 / $3,379.95	Professional		$2,670.75	$2,670.75	$3,379.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $657.16 / $657.16 / $856.05	Professional	26	$657.16	$657.16	$856.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,013.59 / $2,013.59 / $2,523.98	Professional	TC	$2,013.59	$2,013.59	$2,523.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $372.78 / $644.74 / $1,052.61	Professional		$372.78	$644.74	$1,052.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $133.30 / $169.19 / $234.52	Professional	26	$133.30	$169.19	$234.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $374.67 / $475.55 / $707.37	Professional	TC	$374.67	$475.55	$707.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $123.87 / $383.95 / $657.70	Professional		$123.87	$383.95	$657.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $348.85 / $469.86 / $871.16	Professional		$348.85	$469.86	$871.16
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $90.56 / $120.15 / $201.93	Professional	26	$90.56	$120.15	$201.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $265.70 / $352.93 / $645.17	Professional	TC	$265.70	$352.93	$645.17
United Facility/Professional Professional Modifier Low / Median / High Price $368.69 / $571.76 / $753.89	Professional		$368.69	$571.76	$753.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.48 / $131.22 / $179.45	Professional	26	$87.48	$131.22	$179.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.51 / $434.39 / $597.55	Professional	TC	$296.51	$434.39	$597.55
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $333.49 / $372.78 / $530.98	Professional		$333.49	$372.78	$530.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $87.51 / $100.43 / $139.35	Professional	26	$87.51	$100.43	$139.35
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $245.98 / $272.35 / $391.64	Professional	TC	$245.98	$272.35	$391.64