Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $380.19 / $616.60	Facility		$77.62	$380.19	$616.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $42.66 / $54.95	Facility	26	$38.90	$42.66	$54.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $79.43 / $275.42	Professional		$45.71	$79.43	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $117.49	Professional	26	$33.11	$45.71	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.11 / $147.91	Professional	TC	$25.12	$33.11	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $32.36 / $83.18	Professional		$28.18	$32.36	$83.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $41.69 / $51.29	Professional	26	$34.67	$41.69	$51.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $12.02 / $26.92	Professional	TC	$10.47	$12.02	$26.92
BCBS Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $46.77 / $213.80	Facility		$29.51	$46.77	$213.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $48.98 / $75.86	Professional		$29.51	$48.98	$75.86
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $24.55 / $128.82	Facility		$21.38	$24.55	$128.82
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $79.43 / $120.23	Professional		$30.20	$79.43	$120.23
Christus Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $123.03 / $123.03	Facility		$64.57	$123.03	$123.03
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $19.50 / $36.31	Professional	26	$19.50	$19.50	$36.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $128.82 / $338.84	Professional		$67.61	$128.82	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $67.61 / $138.04	Professional	26	$38.02	$67.61	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $50.12 / $204.17	Professional	TC	$28.18	$50.12	$204.17
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $56.23 / $2,951.21	Facility		$54.95	$56.23	$2,951.21
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $323.59 / $323.59 / $323.59	Facility	26	$323.59	$323.59	$323.59
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,174.90 / $1,318.26	Professional		$1,174.90	$1,174.90	$1,318.26
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $630.96 / $630.96 / $630.96	Professional	26	$630.96	$630.96	$630.96
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $870.96 / $870.96 / $870.96	Professional	TC	$870.96	$870.96	$870.96
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $107.15 / $346.74	Facility		$64.57	$107.15	$346.74
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $42.66 / $54.95	Facility	26	$36.31	$42.66	$54.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $81.28 / $263.03	Professional		$60.26	$81.28	$263.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $46.77 / $100.00	Professional	26	$33.88	$46.77	$100.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.88 / $141.25	Professional	TC	$25.12	$33.88	$141.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $32.36 / $53.70	Professional		$22.39	$32.36	$53.70
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $251.19 / $426.58	Professional		$100.00	$251.19	$426.58
Providence Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $112.20 / $323.59	Facility		$64.57	$112.20	$323.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $131.83 / $331.13	Professional		$66.07	$131.83	$331.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $66.07 / $138.04	Professional	26	$38.02	$66.07	$138.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $51.29 / $204.17	Professional	TC	$28.18	$51.29	$204.17
United Facility/Professional Facility Modifier Low / Median / High Price $158.49 / $1,047.13 / $2,691.53	Facility		$158.49	$1,047.13	$2,691.53
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $109.65 / $302.00	Professional		$58.88	$109.65	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $61.66 / $112.20	Professional	26	$33.88	$61.66	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $47.86 / $181.97	Professional	TC	$25.12	$47.86	$181.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $67.61 / $79.43	Professional		$48.98	$67.61	$79.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $38.02 / $44.67	Professional	26	$27.54	$38.02	$44.67
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $29.51 / $34.67	Professional	TC	$21.38	$29.51	$34.67