Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $467.74 / $977.24	Facility		$97.72	$467.74	$977.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $19.05 / $22.39	Facility	26	$16.98	$19.05	$22.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $102.33 / $223.87	Professional		$72.44	$102.33	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.92 / $67.61	Professional	26	$19.95	$26.92	$67.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $75.86 / $131.83	Professional	TC	$48.98	$75.86	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $97.72 / $162.18	Professional		$79.43	$97.72	$162.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $27.54 / $48.98	Professional	26	$19.95	$27.54	$48.98
BCBS Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $190.55 / $331.13	Facility		$74.13	$190.55	$331.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $89.13 / $104.71	Professional		$21.38	$89.13	$104.71
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $181.97 / $446.68	Facility		$104.71	$181.97	$446.68
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $114.82 / $194.98	Professional		$104.71	$114.82	$194.98
Christus Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $131.83 / $131.83	Facility		$104.71	$131.83	$131.83
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $26.92 / $26.92	Professional	26	$25.12	$26.92	$26.92
Cigna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $234.42 / $257.04	Facility		$91.20	$234.42	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $100.00 / $162.18	Professional		$67.61	$100.00	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $26.92 / $48.98	Professional	26	$21.38	$26.92	$48.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $74.13 / $123.03	Professional	TC	$45.71	$74.13	$123.03
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $758.58 / $758.58	Facility		$758.58	$758.58	$758.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $169.82 / $169.82	Facility	26	$169.82	$169.82	$169.82
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $954.99 / $954.99	Professional		$758.58	$954.99	$954.99
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $213.80 / $213.80	Professional	26	$169.82	$213.80	$213.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $741.31 / $741.31	Professional	TC	$588.84	$741.31	$741.31
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $147.91 / $741.31	Facility		$87.10	$147.91	$741.31
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $19.05 / $21.88	Facility	26	$16.98	$19.05	$21.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $131.83 / $229.09	Professional		$75.86	$131.83	$229.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $32.36 / $63.10	Professional	26	$19.95	$32.36	$63.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $100.00 / $173.78	Professional	TC	$54.95	$100.00	$173.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $91.20	Professional		$32.36	$33.11	$91.20
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $2,089.30 / $2,089.30	Facility		$2,089.30	$2,089.30	$2,089.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $177.83 / $316.23	Professional		$141.25	$177.83	$316.23
Providence Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $123.03 / $229.09	Facility		$83.18	$123.03	$229.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $100.00 / $186.21	Professional		$67.61	$100.00	$186.21
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $26.92 / $48.98	Professional	26	$22.39	$26.92	$48.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $74.13 / $128.82	Professional	TC	$44.67	$74.13	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $93.33 / $138.04	Professional		$72.44	$93.33	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $26.92 / $37.15	Professional	26	$21.88	$26.92	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $64.57 / $97.72	Professional	TC	$47.86	$64.57	$97.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $120.23 / $120.23	Professional		$114.82	$120.23	$120.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $27.54 / $27.54	Professional	26	$26.30	$27.54	$27.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $93.33 / $93.33	Professional	TC	$89.13	$93.33	$93.33