Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.25 / $230.10 / $369.11	Facility	26	$181.25	$230.10	$369.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $706.40 / $1,012.82 / $1,638.08	Professional		$706.40	$1,012.82	$1,638.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $181.25 / $284.62 / $518.13	Professional	26	$181.25	$284.62	$518.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $525.14 / $728.19 / $1,210.05	Professional	TC	$525.14	$728.19	$1,210.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $855.20 / $913.40 / $982.15	Professional		$855.20	$913.40	$982.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $252.83 / $273.43 / $352.82	Professional	26	$252.83	$273.43	$352.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $228.88 / $738.88 / $1,416.39	Professional		$228.88	$738.88	$1,416.39
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $1,342.25 / $1,342.25 / $1,581.26	Professional		$1,342.25	$1,342.25	$1,581.26
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $281.64 / $287.83 / $287.83	Professional	26	$281.64	$287.83	$287.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,083.75 / $1,407.01 / $2,028.57	Professional		$1,083.75	$1,407.01	$2,028.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $305.25 / $397.90 / $599.08	Professional	26	$305.25	$397.90	$599.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $781.61 / $996.60 / $1,426.42	Professional	TC	$781.61	$996.60	$1,426.42
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2,118.00 / $2,579.04 / $2,654.96	Facility	26	$2,118.00	$2,579.04	$2,654.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,888.39 / $6,888.39 / $8,413.43	Professional		$6,888.39	$6,888.39	$8,413.43
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,791.90 / $1,791.90 / $2,413.42	Professional	26	$1,791.90	$1,791.90	$2,413.42
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,096.49 / $5,096.49 / $5,999.93	Professional	TC	$5,096.49	$5,096.49	$5,999.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $391.80 / $1,444.44 / $6,056.00	Professional		$391.80	$1,444.44	$6,056.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $360.79 / $416.30 / $485.68	Professional	26	$360.79	$416.30	$485.68
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $891.05 / $1,028.13 / $1,199.49	Professional	TC	$891.05	$1,028.13	$1,199.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $515.95 / $1,378.38 / $3,403.61	Professional		$515.95	$1,378.38	$3,403.61
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,074.08 / $1,445.04 / $2,120.37	Professional		$1,074.08	$1,445.04	$2,120.37
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $302.50 / $397.90 / $589.41	Professional	26	$302.50	$397.90	$589.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $759.96 / $1,004.59 / $1,375.75	Professional	TC	$759.96	$1,004.59	$1,375.75
United Facility/Professional Professional Modifier Low / Median / High Price $877.98 / $1,148.84 / $1,826.87	Professional		$877.98	$1,148.84	$1,826.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $247.14 / $339.12 / $525.17	Professional	26	$247.14	$339.12	$525.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $630.84 / $800.31 / $1,297.80	Professional	TC	$630.84	$800.31	$1,297.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $821.86 / $919.57 / $1,303.88	Professional		$821.86	$919.57	$1,303.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $236.86 / $271.86 / $372.37	Professional	26	$236.86	$271.86	$372.37
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $584.99 / $647.71 / $931.51	Professional	TC	$584.99	$647.71	$931.51