Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $173.78 / $331.13	Facility		$165.96	$173.78	$331.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $120.23 / $120.23 / $120.23	Facility	TC	$120.23	$120.23	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $97.72 / $323.59	Professional		$63.10	$97.72	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $58.88 / $380.19	Professional	26	$22.39	$58.88	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $60.26 / $173.78	Professional	TC	$39.81	$60.26	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $64.57 / $141.25	Professional		$40.74	$64.57	$141.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $32.36 / $44.67	Professional	26	$16.22	$32.36	$44.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $38.90 / $50.12	Professional	TC	$36.31	$38.90	$50.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $23.44 / $23.44	Facility		$23.44	$23.44	$23.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $61.66 / $151.36	Professional		$18.20	$61.66	$151.36
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $125.89	Facility		$109.65	$109.65	$125.89
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $128.82 / $177.83	Professional		$100.00	$128.82	$177.83
Christus Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $107.15 / $128.82	Facility		$102.33	$107.15	$128.82
Christus Facility/Professional Facility Modifier TC Low / Median / High Price $70.79 / $72.44 / $74.13	Facility	TC	$70.79	$72.44	$74.13
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $32.36 / $32.36	Professional	26	$31.62	$32.36	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $66.07 / $190.55	Professional		$45.71	$66.07	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $24.55 / $81.28	Professional	26	$16.60	$24.55	$81.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $39.81 / $134.90	Professional	TC	$28.84	$39.81	$134.90
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Facility		$645.65	$645.65	$645.65
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $436.52 / $436.52 / $436.52	Facility	TC	$436.52	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $660.69 / $933.25	Professional		$134.90	$660.69	$933.25
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $269.15 / $275.42	Professional	26	$269.15	$269.15	$275.42
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $676.08 / $676.08	Professional	TC	$426.58	$676.08	$676.08
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $114.82 / $190.55	Facility		$83.18	$114.82	$190.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $112.20 / $275.42	Professional		$61.66	$112.20	$275.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $44.67 / $251.19	Professional	26	$21.38	$44.67	$251.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $75.86 / $147.91	Professional	TC	$40.74	$75.86	$147.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $89.13	Professional		$28.18	$33.11	$89.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $109.65 / $223.87	Professional		$34.67	$109.65	$223.87
Providence Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $114.82 / $190.55	Facility		$75.86	$114.82	$190.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $66.07 / $208.93	Professional		$44.67	$66.07	$208.93
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $21.38 / $75.86	Professional	26	$16.60	$21.38	$75.86
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.02 / $125.89	Professional	TC	$27.54	$38.02	$125.89
United Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $52.48 / $87.10	Facility		$34.67	$52.48	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $70.79 / $213.80	Professional		$60.26	$70.79	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $25.12 / $81.28	Professional	26	$21.88	$25.12	$81.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $45.71 / $141.25	Professional	TC	$34.67	$45.71	$141.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $41.69 / $109.65	Professional		$41.69	$41.69	$109.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $14.45 / $33.11	Professional	26	$14.45	$14.45	$33.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $27.54 / $77.62	Professional	TC	$27.54	$27.54	$77.62