Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.02 / $225.62 / $484.79	Professional		$173.02	$225.62	$484.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.98 / $83.58 / $405.00	Professional	26	$49.98	$83.58	$405.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.14 / $152.06 / $327.95	Professional	TC	$123.14	$152.06	$327.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.10 / $172.56 / $400.00	Professional		$126.10	$172.56	$400.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.27 / $75.26 / $101.60	Professional	26	$37.27	$75.26	$101.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.05 / $101.32 / $190.42	Professional	TC	$95.05	$101.32	$190.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.36 / $161.05 / $409.88	Professional		$62.36	$161.05	$409.88
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $122.43 / $296.35 / $445.94	Professional		$122.43	$296.35	$445.94
Christus Facility/Professional Facility Modifier Low / Median / High Price $85.70 / $264.95 / $267.58	Facility		$85.70	$264.95	$267.58
Christus Facility/Professional Facility Modifier TC Low / Median / High Price $182.03 / $190.42 / $201.51	Facility	TC	$182.03	$190.42	$201.51
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $73.48 / $74.54 / $77.50	Professional	26	$73.48	$74.54	$77.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.64 / $157.51 / $482.62	Professional		$104.64	$157.51	$482.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.13 / $49.31 / $200.00	Professional	26	$38.13	$49.31	$200.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.05 / $110.20 / $354.92	Professional	TC	$69.05	$110.20	$354.92
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $702.73 / $1,535.15 / $1,535.15	Facility		$702.73	$1,535.15	$1,535.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $193.05 / $395.34 / $395.34	Facility	26	$193.05	$395.34	$395.34
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $509.68 / $1,139.81 / $1,139.81	Facility	TC	$509.68	$1,139.81	$1,139.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,813.36 / $1,813.36 / $2,402.03	Professional		$1,813.36	$1,813.36	$2,402.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $509.36 / $509.36 / $635.03	Professional	26	$509.36	$509.36	$635.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,303.99 / $1,303.99 / $1,767.00	Professional	TC	$1,303.99	$1,303.99	$1,767.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $170.17 / $277.80 / $419.29	Facility		$170.17	$277.80	$419.29
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $86.11 / $275.60 / $501.20	Professional		$86.11	$275.60	$501.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.83 / $114.99 / $181.21	Professional	26	$95.83	$114.99	$181.21
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.90 / $302.27 / $458.37	Professional	TC	$251.90	$302.27	$458.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $78.94 / $231.68 / $490.88	Professional		$78.94	$231.68	$490.88
Providence Facility/Professional Facility Modifier Low / Median / High Price $170.17 / $261.62 / $451.18	Facility		$170.17	$261.62	$451.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $109.23 / $231.00 / $715.51	Professional		$109.23	$231.00	$715.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.13 / $49.31 / $207.13	Professional	26	$38.13	$49.31	$207.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $70.91 / $112.13 / $354.92	Professional	TC	$70.91	$112.13	$354.92
United Facility/Professional Professional Modifier Low / Median / High Price $127.66 / $187.33 / $558.21	Professional		$127.66	$187.33	$558.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.38 / $52.70 / $173.24	Professional	26	$47.38	$52.70	$173.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $134.91 / $389.76	Professional	TC	$93.33	$134.91	$389.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $108.00 / $148.91 / $278.07	Professional		$108.00	$148.91	$278.07
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.78 / $41.09 / $77.08	Professional	26	$33.78	$41.09	$77.08
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $72.86 / $107.83 / $200.99	Professional	TC	$72.86	$107.83	$200.99