Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.81 / $79.31 / $140.00	Facility	26	$69.81	$79.31	$140.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.11 / $369.12 / $805.60	Professional		$252.11	$369.12	$805.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.15 / $111.15 / $233.13	Professional	26	$75.15	$111.15	$233.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $172.73 / $234.99 / $420.00	Professional	TC	$172.73	$234.99	$420.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.79 / $273.91 / $531.70	Professional		$257.79	$273.91	$531.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.95 / $113.93 / $202.21	Professional	26	$80.95	$113.93	$202.21
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $174.84 / $174.84 / $174.84	Professional	TC	$174.84	$174.84	$174.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.25 / $262.31 / $413.14	Professional		$89.25	$262.31	$413.14
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $321.77 / $451.14 / $628.37	Professional		$321.77	$451.14	$628.37
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $102.65 / $108.46 / $114.80	Professional	26	$102.65	$108.46	$114.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.62 / $124.62 / $124.62	Facility	26	$124.62	$124.62	$124.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $289.32 / $444.59 / $777.02	Professional		$289.32	$444.59	$777.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.31 / $122.82 / $223.07	Professional	26	$82.31	$122.82	$223.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $197.51 / $298.52 / $542.47	Professional	TC	$197.51	$298.52	$542.47
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $796.48 / $999.76 / $1,020.08	Facility	26	$796.48	$999.76	$1,020.08
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,337.81 / $2,337.81 / $2,907.38	Professional		$2,337.81	$2,337.81	$2,907.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $687.65 / $687.65 / $881.25	Professional	26	$687.65	$687.65	$881.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,650.16 / $1,650.16 / $2,026.13	Professional	TC	$1,650.16	$1,650.16	$2,026.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $322.24 / $555.60 / $1,045.50	Professional		$322.24	$555.60	$1,045.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $137.09 / $173.99 / $421.80	Professional	26	$137.09	$173.99	$421.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $294.88 / $381.61 / $925.12	Professional	TC	$294.88	$381.61	$925.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $116.41 / $284.12 / $591.94	Professional		$116.41	$284.12	$591.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $124.62 / $124.62 / $124.62	Facility	26	$124.62	$124.62	$124.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $300.87 / $475.19 / $940.54	Professional		$300.87	$475.19	$940.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $88.14 / $118.09 / $220.22	Professional	26	$88.14	$118.09	$220.22
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $197.51 / $290.74 / $534.96	Professional	TC	$197.51	$290.74	$534.96
United Facility/Professional Professional Modifier Low / Median / High Price $343.26 / $554.16 / $1,057.66	Professional		$343.26	$554.16	$1,057.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.26 / $111.62 / $200.01	Professional	26	$69.26	$111.62	$200.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $243.26 / $439.41 / $778.09	Professional	TC	$243.26	$439.41	$778.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $287.39 / $322.24 / $457.26	Professional		$287.39	$322.24	$457.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $90.00 / $103.70 / $143.02	Professional	26	$90.00	$103.70	$143.02
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $197.39 / $230.72 / $1,400.00	Professional	TC	$197.39	$230.72	$1,400.00