Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $181.97 / $181.97	Facility		$181.97	$181.97	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $104.71 / $371.54	Professional		$72.44	$104.71	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $120.23 / $707.95	Professional	26	$30.20	$120.23	$707.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $66.07 / $380.19	Professional	TC	$46.77	$66.07	$380.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $72.44 / $128.82	Professional		$57.54	$72.44	$128.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $24.55 / $53.70	Professional	26	$19.05	$24.55	$53.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $46.77 / $74.13	Professional	TC	$38.90	$46.77	$74.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $61.66 / $162.18	Professional		$21.88	$61.66	$162.18
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $186.21	Facility		$128.82	$128.82	$186.21
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $131.83 / $204.17	Professional		$61.66	$131.83	$204.17
Christus Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $117.49 / $117.49	Facility		$109.65	$117.49	$117.49
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.90	Professional	26	$38.02	$38.02	$38.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $75.86 / $218.78	Professional		$54.95	$75.86	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $28.84 / $89.13	Professional	26	$19.50	$28.84	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $46.77 / $147.91	Professional	TC	$31.62	$46.77	$147.91
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $758.58 / $758.58	Facility		$758.58	$758.58	$758.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $257.04 / $257.04	Facility	26	$257.04	$257.04	$257.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,000.00 / $1,000.00	Professional		$758.58	$1,000.00	$1,000.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $309.03 / $316.23 / $316.23	Professional	26	$309.03	$316.23	$316.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $676.08 / $676.08	Professional	TC	$512.86	$676.08	$676.08
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $144.54 / $234.42	Facility		$91.20	$144.54	$234.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $141.25 / $269.15	Professional		$72.44	$141.25	$269.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $63.10 / $389.05	Professional	26	$25.12	$63.10	$389.05
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $85.11 / $177.83	Professional	TC	$46.77	$85.11	$177.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $95.50	Professional		$32.36	$33.11	$95.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $120.23 / $245.47	Professional		$41.69	$120.23	$245.47
Providence Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $141.25 / $239.88	Facility		$87.10	$141.25	$239.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $75.86 / $257.04	Professional		$54.95	$75.86	$257.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $27.54 / $87.10	Professional	26	$19.50	$27.54	$87.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $42.66 / $147.91	Professional	TC	$30.90	$42.66	$147.91
United Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $67.61 / $114.82	Facility		$45.71	$67.61	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $83.18 / $257.04	Professional		$72.44	$83.18	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $33.88 / $97.72	Professional	26	$26.30	$33.88	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $53.70 / $165.96	Professional	TC	$38.90	$53.70	$165.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $120.23	Professional		$50.12	$50.12	$120.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $16.98 / $38.90	Professional	26	$16.98	$16.98	$38.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $32.36 / $81.28	Professional	TC	$32.36	$32.36	$81.28