Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.63 / $86.00 / $211.92	Professional		$56.63	$86.00	$211.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.05 / $27.89 / $139.44	Professional	26	$16.05	$27.89	$139.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.41 / $68.98 / $132.38	Professional	TC	$47.41	$68.98	$132.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.86 / $54.64 / $103.35	Professional		$33.86	$54.64	$103.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.57 / $24.49 / $33.06	Professional	26	$8.57	$24.49	$33.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.15 / $41.99 / $64.43	Professional	TC	$27.15	$41.99	$64.43
BCBS Facility/Professional Facility Modifier Low / Median / High Price $57.88 / $57.88 / $57.88	Facility		$57.88	$57.88	$57.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.10 / $60.17 / $158.91	Professional		$26.10	$60.17	$158.91
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $95.00 / $134.88 / $181.79	Professional		$95.00	$134.88	$181.79
Christus Facility/Professional Facility Modifier Low / Median / High Price $50.66 / $103.11 / $105.35	Facility		$50.66	$103.11	$105.35
Christus Facility/Professional Facility Modifier TC Low / Median / High Price $75.39 / $78.86 / $83.97	Facility	TC	$75.39	$78.86	$83.97
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $23.94 / $24.25 / $25.30	Professional	26	$23.94	$24.25	$25.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.36 / $59.02 / $188.18	Professional		$44.36	$59.02	$188.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.62 / $16.02 / $56.35	Professional	26	$12.62	$16.02	$56.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.15 / $45.15 / $145.56	Professional	TC	$33.15	$45.15	$145.56
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $274.05 / $599.64 / $599.64	Facility		$274.05	$599.64	$599.64
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $127.87 / $127.87	Facility	26	$100.00	$127.87	$127.87
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $211.35 / $471.77 / $471.77	Facility	TC	$211.35	$471.77	$471.77
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $715.47 / $715.47 / $937.95	Professional		$715.47	$715.47	$937.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $162.69 / $162.69 / $205.80	Professional	26	$162.69	$162.69	$205.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $552.78 / $552.78 / $732.15	Professional	TC	$552.78	$552.78	$732.15
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $64.84 / $109.06 / $173.67	Facility		$64.84	$109.06	$173.67
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $30.07 / $127.11 / $201.55	Professional		$30.07	$127.11	$201.55
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.14 / $37.36 / $57.86	Professional	26	$31.14	$37.36	$57.86
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.31 / $125.18 / $194.17	Professional	TC	$104.31	$125.18	$194.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.62 / $94.34 / $196.72	Professional		$26.62	$94.34	$196.72
Providence Facility/Professional Facility Modifier Low / Median / High Price $64.84 / $108.52 / $180.86	Facility		$64.84	$108.52	$180.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.45 / $78.12 / $271.35	Professional		$45.45	$78.12	$271.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.60 / $16.02 / $60.24	Professional	26	$12.60	$16.02	$60.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.14 / $45.15 / $138.55	Professional	TC	$32.14	$45.15	$138.55
United Facility/Professional Professional Modifier Low / Median / High Price $56.16 / $64.31 / $197.53	Professional		$56.16	$64.31	$197.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.93 / $17.01 / $55.58	Professional	26	$15.93	$17.01	$55.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.64 / $47.64 / $157.44	Professional	TC	$40.64	$47.64	$157.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $58.25 / $108.28	Professional		$39.74	$58.25	$108.28
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.84 / $13.35 / $25.05	Professional	26	$10.84	$13.35	$25.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $44.90 / $83.22	Professional	TC	$28.51	$44.90	$83.22