Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.79 / $73.44 / $247.26	Professional		$53.79	$73.44	$247.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.12 / $43.12 / $348.60	Professional	26	$17.12	$43.12	$348.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.53 / $48.17 / $205.05	Professional	TC	$36.53	$48.17	$205.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.58 / $51.37 / $108.30	Professional		$30.58	$51.37	$108.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.81 / $16.18 / $33.54	Professional	26	$12.81	$16.18	$33.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.80 / $33.58 / $42.28	Professional	TC	$21.80	$33.58	$42.28
BCBS Facility/Professional Facility Modifier Low / Median / High Price $121.92 / $121.92 / $121.92	Facility		$121.92	$121.92	$121.92
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.73 / $47.90 / $121.92	Professional		$19.73	$47.90	$121.92
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $71.45 / $116.29 / $153.66	Professional		$71.45	$116.29	$153.66
Christus Facility/Professional Facility Modifier Low / Median / High Price $85.91 / $89.08 / $90.76	Facility		$85.91	$89.08	$90.76
Christus Facility/Professional Facility Modifier TC Low / Median / High Price $60.46 / $63.27 / $67.16	Facility	TC	$60.46	$63.27	$67.16
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $25.45 / $25.80 / $26.93	Professional	26	$25.45	$25.80	$26.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.24 / $48.08 / $169.37	Professional		$32.24	$48.08	$169.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.45 / $15.08 / $51.18	Professional	26	$10.45	$15.08	$51.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.80 / $33.58 / $111.99	Professional	TC	$21.80	$33.58	$111.99
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $235.04 / $516.33 / $516.33	Facility		$235.04	$516.33	$516.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $71.22 / $136.56 / $136.56	Facility	26	$71.22	$136.56	$136.56
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $168.30 / $379.76 / $379.76	Facility	TC	$168.30	$379.76	$379.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $559.76 / $559.76 / $804.98	Professional		$559.76	$559.76	$804.98
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $173.52 / $173.52 / $219.45	Professional	26	$173.52	$173.52	$219.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $386.24 / $386.24 / $585.53	Professional	TC	$386.24	$386.24	$585.53
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $60.93 / $98.44 / $169.59	Facility		$60.93	$98.44	$169.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $116.85 / $186.20	Professional		$37.14	$116.85	$186.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.15 / $39.78 / $61.67	Professional	26	$33.15	$39.78	$61.67
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.70 / $100.44 / $135.54	Professional	TC	$83.70	$100.44	$135.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $77.75 / $164.80	Professional		$28.58	$77.75	$164.80
Providence Facility/Professional Facility Modifier Low / Median / High Price $60.11 / $98.44 / $174.78	Facility		$60.11	$98.44	$174.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $32.25 / $70.89 / $221.66	Professional		$32.25	$70.89	$221.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.43 / $15.01 / $51.18	Professional	26	$10.43	$15.01	$51.18
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.80 / $33.58 / $110.81	Professional	TC	$21.80	$33.58	$110.81
United Facility/Professional Professional Modifier Low / Median / High Price $42.98 / $56.65 / $188.38	Professional		$42.98	$56.65	$188.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.87 / $17.95 / $59.18	Professional	26	$13.87	$17.95	$59.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $38.76 / $128.10	Professional	TC	$29.11	$38.76	$128.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $36.72 / $46.92 / $93.50	Professional		$36.72	$46.92	$93.50
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.54 / $14.05 / $26.68	Professional	26	$11.54	$14.05	$26.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $25.19 / $32.86 / $66.81	Professional	TC	$25.19	$32.86	$66.81