Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.06 / $68.89 / $87.33	Facility	26	$55.06	$68.89	$87.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.49 / $294.12 / $634.12	Professional		$204.49	$294.12	$634.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.06 / $69.98 / $150.13	Professional	26	$55.06	$69.98	$150.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.43 / $213.21 / $468.65	Professional	TC	$149.43	$213.21	$468.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $161.35 / $206.02 / $292.30	Professional		$161.35	$206.02	$292.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.91 / $82.71 / $121.64	Professional	26	$49.91	$82.71	$121.64
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $145.01 / $145.01 / $235.35	Professional	TC	$145.01	$145.01	$235.35
BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.10 / $177.96 / $268.77	Professional		$54.10	$177.96	$268.77
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $231.46 / $322.70 / $487.28	Professional		$231.46	$322.70	$487.28
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $61.75 / $65.59 / $202.53	Professional	26	$61.75	$65.59	$202.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.90 / $357.41 / $694.44	Professional		$218.90	$357.41	$694.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.34 / $76.50 / $137.47	Professional	26	$51.34	$76.50	$137.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $163.75 / $275.52 / $542.91	Professional	TC	$163.75	$275.52	$542.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $478.24 / $602.48 / $619.20	Facility	26	$478.24	$602.48	$619.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,308.83 / $2,385.40 / $2,385.40	Professional		$2,308.83	$2,385.40	$2,385.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $533.30 / $533.30 / $533.30	Professional	26	$533.30	$533.30	$533.30
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,603.00 / $2,603.00 / $2,603.00	Professional	TC	$2,603.00	$2,603.00	$2,603.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $103.04 / $382.82 / $961.99	Professional		$103.04	$382.82	$961.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.42 / $104.61 / $253.60	Professional	26	$82.42	$104.61	$253.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $249.35 / $316.49 / $767.24	Professional	TC	$249.35	$316.49	$767.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $70.09 / $220.60 / $437.45	Professional		$70.09	$220.60	$437.45
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $228.38 / $382.06 / $745.45	Professional		$228.38	$382.06	$745.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.14 / $76.50 / $134.12	Professional	26	$55.14	$76.50	$134.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $163.75 / $271.89 / $529.99	Professional	TC	$163.75	$271.89	$529.99
United Facility/Professional Professional Modifier Low / Median / High Price $226.64 / $329.48 / $566.60	Professional		$226.64	$329.48	$566.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.01 / $71.81 / $127.12	Professional	26	$57.01	$71.81	$127.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.18 / $253.78 / $442.79	Professional	TC	$169.18	$253.78	$442.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $205.94 / $230.50 / $327.83	Professional		$205.94	$230.50	$327.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $62.38 / $86.09	Professional	26	$54.11	$62.38	$86.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.84 / $177.49 / $1,100.00	Professional	TC	$151.84	$177.49	$1,100.00