Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $150.93 / $166.13 / $291.25	Facility	26	$150.93	$166.13	$291.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $312.50 / $448.51 / $1,081.84	Professional		$312.50	$448.51	$1,081.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $152.04 / $220.12 / $544.29	Professional	26	$152.04	$220.12	$544.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.59 / $226.55 / $456.00	Professional	TC	$158.59	$226.55	$456.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $354.99 / $443.74 / $777.94	Professional		$354.99	$443.74	$777.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $183.38 / $237.31 / $373.22	Professional	26	$183.38	$237.31	$373.22
BCBS Facility/Professional Professional Modifier Low / Median / High Price $182.78 / $378.10 / $608.51	Professional		$182.78	$378.10	$608.51
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $461.69 / $554.67 / $763.98	Professional		$461.69	$554.67	$763.98
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $213.79 / $226.91 / $226.91	Professional	26	$213.79	$226.91	$226.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $401.20 / $537.95 / $937.33	Professional		$401.20	$537.95	$937.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $191.05 / $258.39 / $431.47	Professional	26	$191.05	$258.39	$431.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $209.69 / $288.02 / $519.55	Professional	TC	$209.69	$288.02	$519.55
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $528.44 / $1,135.96 / $1,135.96	Facility	26	$528.44	$1,135.96	$1,135.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,895.04 / $2,895.04 / $3,961.13	Professional		$2,895.04	$2,895.04	$3,961.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,405.16 / $1,405.16 / $1,841.48	Professional	26	$1,405.16	$1,405.16	$1,841.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,489.88 / $1,489.88 / $2,119.73	Professional	TC	$1,489.88	$1,489.88	$2,119.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $299.64 / $600.22 / $1,111.32	Professional		$299.64	$600.22	$1,111.32
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $286.36 / $363.46 / $692.37	Professional	26	$286.36	$363.46	$692.37
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $313.69 / $398.15 / $524.61	Professional	TC	$313.69	$398.15	$524.61
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $250.17 / $386.96 / $811.58	Professional		$250.17	$386.96	$811.58
Providence Facility/Professional Professional Modifier Low / Median / High Price $405.03 / $537.95 / $964.60	Professional		$405.03	$537.95	$964.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $192.88 / $258.39 / $433.19	Professional	26	$192.88	$258.39	$433.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $209.76 / $288.02 / $532.63	Professional	TC	$209.76	$288.02	$532.63
United Facility/Professional Professional Modifier Low / Median / High Price $422.71 / $621.64 / $845.43	Professional		$422.71	$621.64	$845.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $197.56 / $289.91 / $365.09	Professional	26	$197.56	$289.91	$365.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $238.40 / $330.16 / $448.19	Professional	TC	$238.40	$330.16	$448.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $393.94 / $443.74 / $626.83	Professional		$393.94	$443.74	$626.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $188.00 / $215.74 / $299.24	Professional	26	$188.00	$215.74	$299.24
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $205.94 / $228.00 / $327.58	Professional	TC	$205.94	$228.00	$327.58