Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.28 / $107.28 / $214.56	Facility		$107.28	$107.28	$214.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.39 / $78.50 / $365.89	Professional		$50.39	$78.50	$365.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.24 / $63.00 / $339.15	Professional	26	$24.24	$63.00	$339.15
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.59 / $26.12 / $58.67	Professional	52	$21.59	$26.12	$58.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.00 / $40.21 / $160.74	Professional	TC	$22.00	$40.21	$160.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $35.14 / $84.05	Professional		$22.39	$35.14	$84.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.86 / $18.93 / $40.98	Professional	26	$16.86	$18.93	$40.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $10.92 / $17.42 / $31.37	Professional	TC	$10.92	$17.42	$31.37
BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.42 / $54.42 / $54.42	Facility		$54.42	$54.42	$54.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.32 / $54.65 / $142.05	Professional		$35.32	$54.65	$142.05
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $49.20 / $94.55 / $165.00	Professional		$49.20	$94.55	$165.00
Christus Facility/Professional Facility Modifier Low / Median / High Price $49.57 / $66.70 / $70.28	Facility		$49.57	$66.70	$70.28
Christus Facility/Professional Facility Modifier TC Low / Median / High Price $31.27 / $32.70 / $34.85	Facility	TC	$31.27	$32.70	$34.85
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $34.68 / $68.92	Professional	26	$33.54	$34.68	$68.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.46 / $52.88 / $150.00	Professional		$34.46	$52.88	$150.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.72 / $22.48 / $120.00	Professional	26	$17.72	$22.48	$120.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.70 / $31.55 / $78.89	Professional	TC	$15.70	$31.55	$78.89
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $213.86 / $375.35 / $375.35	Facility		$213.86	$375.35	$375.35
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $179.84 / $179.84	Facility	26	$100.00	$179.84	$179.84
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $132.57 / $216.27 / $216.27	Facility	TC	$132.57	$216.27	$216.27
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $237.00 / $563.97 / $592.20	Professional		$237.00	$563.97	$592.20
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $292.24 / $292.24 / $292.24	Professional	26	$292.24	$292.24	$292.24
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $349.50 / $352.47 / $359.07	Professional	TC	$349.50	$352.47	$359.07
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $64.56 / $100.58 / $165.04	Facility		$64.56	$100.58	$165.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $44.00 / $92.64 / $208.00	Professional		$44.00	$92.64	$208.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.66 / $52.40 / $82.24	Professional	26	$43.66	$52.40	$82.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.26 / $55.38 / $76.14	Professional	TC	$43.26	$55.38	$76.14
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $31.33 / $57.55 / $129.88	Professional		$31.33	$57.55	$129.88
Providence Facility/Professional Facility Modifier Low / Median / High Price $63.23 / $100.58 / $167.91	Facility		$63.23	$100.58	$167.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $34.46 / $74.19 / $187.84	Professional		$34.46	$74.19	$187.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.69 / $22.48 / $141.36	Professional	26	$17.69	$22.48	$141.36
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $77.18 / $80.54 / $85.26	Professional	52	$77.18	$80.54	$85.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $15.16 / $28.57 / $78.89	Professional	TC	$15.16	$28.57	$78.89
United Facility/Professional Professional Modifier Low / Median / High Price $42.88 / $61.40 / $161.99	Professional		$42.88	$61.40	$161.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.71 / $24.15 / $86.55	Professional	26	$21.71	$24.15	$86.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.27 / $29.03 / $89.06	Professional	TC	$19.27	$29.03	$89.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $27.87 / $52.80 / $69.66	Professional		$27.87	$52.80	$69.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.34 / $24.13 / $35.15	Professional	26	$15.34	$24.13	$35.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $12.53 / $18.21 / $34.51	Professional	TC	$12.53	$18.21	$34.51