Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $251.19 / $371.54	Facility	26	$181.97	$251.19	$371.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,096.48 / $1,862.09	Professional		$812.83	$1,096.48	$1,862.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $316.23 / $645.65	Professional	26	$229.09	$316.23	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $794.33 / $1,230.27	Professional	TC	$575.44	$794.33	$1,230.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $323.59 / $389.05	Professional	26	$269.15	$323.59	$389.05
BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $724.44 / $1,380.38	Professional		$234.42	$724.44	$1,380.38
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,548.82 / $1,584.89	Professional		$1,412.54	$1,548.82	$1,584.89
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $288.40 / $288.40	Professional	26	$281.84	$288.40	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,412.54 / $2,041.74	Professional		$1,071.52	$1,412.54	$2,041.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $398.11 / $602.56	Professional	26	$302.00	$398.11	$602.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $758.58 / $1,000.00 / $1,479.11	Professional	TC	$758.58	$1,000.00	$1,479.11
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Facility	26	$2,570.40	$2,570.40	$2,570.40
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,918.31 / $8,317.64 / $8,317.64	Professional		$6,918.31	$8,317.64	$8,317.64
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,778.28 / $2,398.83 / $2,398.83	Professional	26	$1,778.28	$2,398.83	$2,398.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,128.61 / $6,025.60 / $6,025.60	Professional	TC	$5,128.61	$6,025.60	$6,025.60
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $251.19 / $371.54	Facility	26	$181.97	$251.19	$371.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,318.26 / $2,344.23	Professional		$870.96	$1,318.26	$2,344.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $363.08 / $616.60	Professional	26	$229.09	$363.08	$616.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $933.25 / $1,380.38	Professional	TC	$630.96	$933.25	$1,380.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $724.44	Professional		$32.36	$33.11	$724.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $2,630.27 / $3,715.35	Professional		$1,023.29	$2,630.27	$3,715.35
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,380.38 / $1,995.26	Professional		$1,047.13	$1,380.38	$1,995.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $398.11 / $588.84	Professional	26	$302.00	$398.11	$588.84
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $1,000.00 / $1,412.54	Professional	TC	$741.31	$1,000.00	$1,412.54
United Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,148.15 / $1,819.70	Professional		$870.96	$1,148.15	$1,819.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $338.84 / $524.81	Professional	26	$245.47	$338.84	$524.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $831.76 / $1,288.25	Professional	TC	$630.96	$831.76	$1,288.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $954.99 / $1,023.29	Professional		$954.99	$954.99	$1,023.29
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $275.42 / $275.42 / $302.00	Professional	26	$275.42	$275.42	$302.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $691.83 / $724.44	Professional	TC	$691.83	$691.83	$724.44