Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $269.15 / $275.42	Facility		$257.04	$269.15	$275.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $67.61 / $112.20	Professional		$46.77	$67.61	$112.20
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	25	$81.28	$81.28	$81.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $25.70 / $43.65	Professional	26	$19.05	$25.70	$43.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	52	$61.66	$61.66	$61.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $33.88 / $60.26	Professional	TC	$25.70	$33.88	$60.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $61.66 / $79.43	Professional		$54.95	$61.66	$79.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $26.30 / $43.65	Professional	26	$26.30	$26.30	$43.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $33.88 / $50.12	Professional	TC	$33.11	$33.88	$50.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $112.20 / $380.19	Facility		$69.18	$112.20	$380.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $45.71 / $51.29	Professional		$21.38	$45.71	$51.29
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $67.61 / $100.00	Professional		$61.66	$67.61	$100.00
Christus Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $37.15 / $37.15	Professional	26	$25.70	$37.15	$37.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $72.44 / $134.90	Professional		$50.12	$72.44	$134.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $29.51 / $46.77	Professional	26	$21.88	$29.51	$46.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $41.69 / $79.43	Professional	TC	$29.51	$41.69	$79.43
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $398.11 / $398.11	Facility		$398.11	$398.11	$398.11
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $165.96 / $165.96	Facility	26	$165.96	$165.96	$165.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $407.38 / $524.81	Professional		$61.66	$407.38	$524.81
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $213.80 / $213.80	Professional	26	$165.96	$213.80	$213.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $309.03 / $309.03	Professional	TC	$263.03	$309.03	$309.03
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $67.61 / $117.49	Facility		$43.65	$67.61	$117.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $60.26 / $109.65	Professional		$44.67	$60.26	$109.65
Moda Health Facility/Professional Professional Modifier 25 Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	25	$81.28	$81.28	$81.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $25.70 / $47.86	Professional	26	$18.20	$25.70	$47.86
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	52	$61.66	$61.66	$61.66
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $34.67 / $64.57	Professional	TC	$24.55	$34.67	$64.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $32.36 / $54.95	Professional		$20.89	$32.36	$54.95
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $37.15 / $63.10	Professional		$26.30	$37.15	$63.10
Providence Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $67.61 / $117.49	Facility		$45.71	$67.61	$117.49
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $74.13 / $138.04	Professional		$52.48	$74.13	$138.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $30.20 / $54.95	Professional	26	$22.39	$30.20	$54.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $42.66 / $81.28	Professional	TC	$30.20	$42.66	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $64.57 / $102.33	Professional		$47.86	$64.57	$102.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $25.12 / $37.15	Professional	26	$20.42	$25.12	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $38.02 / $64.57	Professional	TC	$26.92	$38.02	$64.57
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $56.23 / $64.57	Professional		$52.48	$56.23	$64.57
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $25.70 / $26.30	Professional	26	$23.44	$25.70	$26.30
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $35.48 / $37.15	Professional	TC	$33.11	$35.48	$37.15