Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.70 / $80.91 / $171.60	Professional		$59.70	$80.91	$171.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.86 / $65.84 / $615.60	Professional	26	$37.86	$65.84	$615.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.51 / $31.70 / $69.48	Professional	TC	$24.51	$31.70	$69.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.59 / $50.14 / $158.88	Professional		$45.59	$50.14	$158.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.30 / $57.13 / $79.76	Professional	26	$28.30	$57.13	$79.76
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Professional	TC	$18.64	$18.64	$18.64
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.01 / $85.39 / $143.74	Professional		$48.01	$85.39	$143.74
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $94.42 / $133.82 / $172.47	Professional		$94.42	$133.82	$172.47
Christus Facility/Professional Facility Modifier Low / Median / High Price $63.79 / $93.88 / $94.64	Facility		$63.79	$93.88	$94.64
Christus Facility/Professional Facility Modifier TC Low / Median / High Price $35.65 / $37.29 / $39.46	Facility	TC	$35.65	$37.29	$39.46
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $55.76 / $56.59 / $58.51	Professional	26	$55.76	$56.59	$58.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.28 / $62.99 / $187.71	Professional		$44.28	$62.99	$187.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.82 / $39.18 / $127.55	Professional	26	$28.82	$39.18	$127.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.28 / $21.34 / $69.30	Professional	TC	$14.28	$21.34	$69.30
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $246.39 / $523.92 / $523.92	Facility		$246.39	$523.92	$523.92
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $146.41 / $300.87 / $300.87	Facility	26	$146.41	$300.87	$300.87
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $223.06 / $223.06	Facility	TC	$100.00	$223.06	$223.06
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $643.49 / $643.49 / $828.68	Professional		$643.49	$643.49	$828.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $383.71 / $383.71 / $482.40	Professional	26	$383.71	$383.71	$482.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $350.03 / $350.03 / $350.03	Professional	TC	$350.03	$350.03	$350.03
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $83.67 / $115.94 / $179.73	Facility		$83.67	$115.94	$179.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $85.05 / $141.05 / $249.31	Professional		$85.05	$141.05	$249.31
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.78 / $87.33 / $136.29	Professional	26	$72.78	$87.33	$136.29
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.33 / $59.19 / $91.37	Professional	TC	$49.33	$59.19	$91.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $37.84 / $70.95 / $172.90	Professional		$37.84	$70.95	$172.90
Providence Facility/Professional Facility Modifier Low / Median / High Price $80.69 / $117.07 / $196.01	Facility		$80.69	$117.07	$196.01
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.02 / $83.64 / $261.86	Professional		$45.02	$83.64	$261.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.82 / $37.25 / $132.56	Professional	26	$28.82	$37.25	$132.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $14.92 / $21.95 / $69.30	Professional	TC	$14.92	$21.95	$69.30
United Facility/Professional Professional Modifier Low / Median / High Price $53.76 / $61.49 / $200.66	Professional		$53.76	$61.49	$200.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.68 / $40.09 / $130.63	Professional	26	$35.68	$40.09	$130.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.48 / $21.01 / $69.42	Professional	TC	$17.48	$21.01	$69.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $39.13 / $52.36 / $97.90	Professional		$39.13	$52.36	$97.90
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.47 / $31.04 / $58.55	Professional	26	$25.47	$31.04	$58.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $13.48 / $21.32 / $39.35	Professional	TC	$13.48	$21.32	$39.35