Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $280.77 / $308.87 / $543.52	Facility	26	$280.77	$308.87	$543.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,255.02 / $1,889.42 / $5,314.49	Professional		$1,255.02	$1,889.42	$5,314.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $282.87 / $408.69 / $1,003.14	Professional	26	$282.87	$408.69	$1,003.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $960.29 / $1,371.85 / $2,789.78	Professional	TC	$960.29	$1,371.85	$2,789.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,370.32 / $1,712.90 / $2,963.32	Professional		$1,370.32	$1,712.90	$2,963.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $342.22 / $442.87 / $696.51	Professional	26	$342.22	$442.87	$696.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $340.73 / $1,498.76 / $2,085.16	Professional		$340.73	$1,498.76	$2,085.16
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $1,795.41 / $2,170.19 / $3,008.81	Professional		$1,795.41	$2,170.19	$3,008.81
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $398.99 / $422.47 / $422.47	Professional	26	$398.99	$422.47	$422.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,575.87 / $2,087.53 / $3,786.30	Professional		$1,575.87	$2,087.53	$3,786.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $355.52 / $482.62 / $813.05	Professional	26	$355.52	$482.62	$813.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,218.49 / $1,630.83 / $2,961.43	Professional	TC	$1,218.49	$1,630.83	$2,961.43
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $985.21 / $2,118.79 / $2,118.79	Facility	26	$985.21	$2,118.79	$2,118.79
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $11,628.82 / $13,988.24 / $15,609.38	Professional		$11,628.82	$13,988.24	$15,609.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2,613.17 / $2,958.87 / $3,439.95	Professional	26	$2,613.17	$2,958.87	$3,439.95
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $9,015.64 / $9,015.64 / $12,169.43	Professional	TC	$9,015.64	$9,015.64	$12,169.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $557.42 / $2,337.17 / $4,101.00	Professional		$557.42	$2,337.17	$4,101.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $534.46 / $678.35 / $931.22	Professional	26	$534.46	$678.35	$931.22
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,802.70 / $2,288.04 / $3,169.78	Professional	TC	$1,802.70	$2,288.04	$3,169.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $496.01 / $1,815.25 / $3,172.95	Professional		$496.01	$1,815.25	$3,172.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,577.58 / $2,106.98 / $3,825.85	Professional		$1,577.58	$2,106.98	$3,825.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $359.10 / $482.62 / $813.05	Professional	26	$359.10	$482.62	$813.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,218.49 / $1,674.70 / $3,020.76	Professional	TC	$1,218.49	$1,674.70	$3,020.76
United Facility/Professional Professional Modifier Low / Median / High Price $1,559.36 / $2,449.84 / $3,253.22	Professional		$1,559.36	$2,449.84	$3,253.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $362.56 / $475.12 / $679.70	Professional	26	$362.56	$475.12	$679.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,218.65 / $1,931.30 / $2,405.83	Professional	TC	$1,218.65	$1,931.30	$2,405.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,534.39 / $1,712.90 / $2,441.46	Professional		$1,534.39	$1,712.90	$2,441.46
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $350.88 / $402.61 / $558.37	Professional	26	$350.88	$402.61	$558.37
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $1,183.50 / $1,310.30 / $1,883.10	Professional	TC	$1,183.50	$1,310.30	$1,883.10