Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.12 / $80.59 / $127.64	Facility	26	$62.12	$80.59	$127.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $570.70 / $756.17 / $2,687.20	Professional		$570.70	$756.17	$2,687.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.12 / $81.48 / $266.13	Professional	26	$62.12	$81.48	$266.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $508.59 / $650.90 / $1,223.50	Professional	TC	$508.59	$650.90	$1,223.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $177.77 / $177.77 / $177.77	Professional	26	$177.77	$177.77	$177.77
BCBS Facility/Professional Professional Modifier Low / Median / High Price $101.00 / $647.03 / $909.19	Professional		$101.00	$647.03	$909.19
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $403.00 / $403.00 / $1,260.63	Professional		$403.00	$403.00	$1,260.63
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $90.21 / $92.92 / $102.33	Professional	26	$90.21	$92.92	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $662.60 / $1,010.04 / $1,685.44	Professional		$662.60	$1,010.04	$1,685.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.20 / $117.48 / $192.39	Professional	26	$79.20	$117.48	$192.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $583.39 / $894.93 / $1,500.37	Professional	TC	$583.39	$894.93	$1,500.37
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $229.45 / $468.97 / $468.97	Facility	26	$229.45	$468.97	$468.97
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,628.92 / $5,628.92 / $6,769.20	Professional		$5,628.92	$5,628.92	$6,769.20
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $611.21 / $611.21 / $766.58	Professional	26	$611.21	$611.21	$766.58
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,017.71 / $5,017.71 / $6,002.63	Professional	TC	$5,017.71	$5,017.71	$6,002.63
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $738.24 / $1,336.21 / $2,030.40	Professional		$738.24	$1,336.21	$2,030.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $132.10 / $165.13 / $370.04	Professional	26	$132.10	$165.13	$370.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $977.87 / $1,222.33 / $2,739.12	Professional	TC	$977.87	$1,222.33	$2,739.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $110.95 / $825.68 / $940.46	Professional		$110.95	$825.68	$940.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $702.13 / $1,063.24 / $1,694.02	Professional		$702.13	$1,063.24	$1,694.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $81.65 / $122.80 / $192.39	Professional	26	$81.65	$122.80	$192.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $621.29 / $927.78 / $1,510.26	Professional	TC	$621.29	$927.78	$1,510.26
United Facility/Professional Professional Modifier Low / Median / High Price $764.52 / $906.60 / $1,422.15	Professional		$764.52	$906.60	$1,422.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.73 / $103.83 / $156.99	Professional	26	$83.73	$103.83	$156.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $680.79 / $802.61 / $1,266.40	Professional	TC	$680.79	$802.61	$1,266.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $663.39 / $738.24 / $1,055.92	Professional		$663.39	$738.24	$1,055.92
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $78.95 / $91.17 / $125.69	Professional	26	$78.95	$91.17	$125.69
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $584.44 / $647.07 / $930.23	Professional	TC	$584.44	$647.07	$930.23