Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.45 / $84.41 / $106.93	Facility	26	$57.45	$84.41	$106.93
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $35.36 / $85.02 / $332.81	Facility	53	$35.36	$85.02	$332.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.36 / $321.87 / $630.00	Professional		$189.36	$321.87	$630.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.43 / $106.93 / $274.00	Professional	26	$65.43	$106.93	$274.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $94.68 / $139.63 / $273.75	Professional	52	$94.68	$139.63	$273.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.93 / $206.81 / $422.10	Professional	TC	$123.93	$206.81	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $129.78 / $158.07 / $354.06	Professional		$129.78	$158.07	$354.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.95 / $72.81 / $129.07	Professional	26	$52.95	$72.81	$129.07
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $329.57 / $329.57 / $329.57	Professional	52	$329.57	$329.57	$329.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $83.45 / $95.36 / $119.21	Professional	TC	$83.45	$95.36	$119.21
BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.67 / $151.62 / $241.11	Professional		$57.67	$151.62	$241.11
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $185.39 / $296.62 / $495.00	Professional		$185.39	$296.62	$495.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $65.52 / $69.42 / $106.75	Professional	26	$65.52	$69.42	$106.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.36 / $372.45 / $765.30	Professional		$166.36	$372.45	$765.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.75 / $85.14 / $151.75	Professional	26	$54.75	$85.14	$151.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.77 / $242.15 / $618.23	Professional	TC	$107.77	$242.15	$618.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $507.76 / $638.88 / $656.72	Facility	26	$507.76	$638.88	$656.72
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $85.26 / $285.58 / $285.58	Facility	53	$85.26	$285.58	$285.58
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,872.81 / $2,958.99 / $2,958.99	Professional		$2,872.81	$2,958.99	$2,958.99
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $584.49 / $584.49 / $584.49	Professional	26	$584.49	$584.49	$584.49
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,498.98 / $2,573.94 / $2,573.94	Professional	TC	$2,498.98	$2,573.94	$2,573.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $111.44 / $276.22 / $836.48	Professional		$111.44	$276.22	$836.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.46 / $117.74 / $269.12	Professional	26	$87.46	$117.74	$269.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.00 / $220.76 / $319.16	Professional	TC	$164.00	$220.76	$319.16
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.42 / $155.11 / $351.95	Professional		$74.42	$155.11	$351.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $173.69 / $381.83 / $732.54	Professional		$173.69	$381.83	$732.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.59 / $84.51 / $150.00	Professional	26	$58.59	$84.51	$150.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $110.25 / $244.26 / $618.23	Professional	TC	$110.25	$244.26	$618.23
United Facility/Professional Professional Modifier Low / Median / High Price $191.32 / $273.43 / $584.66	Professional		$191.32	$273.43	$584.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.24 / $76.15 / $144.69	Professional	26	$60.24	$76.15	$144.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $127.91 / $183.54 / $435.10	Professional	TC	$127.91	$183.54	$435.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.09 / $185.39 / $262.70	Professional		$165.09	$185.39	$262.70
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.42 / $66.19 / $91.33	Professional	26	$57.42	$66.19	$91.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $107.67 / $125.84 / $1,400.00	Professional	TC	$107.67	$125.84	$1,400.00