Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $138.04 / $165.96	Facility	26	$100.00	$138.04	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $575.44 / $1,479.11	Professional		$398.11	$575.44	$1,479.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $144.54 / $323.59	Professional	26	$89.13	$144.54	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $436.52 / $776.25	Professional	TC	$302.00	$436.52	$776.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $354.81 / $416.87	Professional		$354.81	$354.81	$416.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $102.33 / $199.53	Professional	26	$81.28	$102.33	$199.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $537.03	Professional	TC	$338.84	$338.84	$537.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $371.54 / $478.63	Professional		$83.18	$371.54	$478.63
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $630.96 / $1,047.13	Professional		$416.87	$630.96	$1,047.13
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $102.33 / $107.15	Professional	26	$100.00	$102.33	$107.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $123.03 / $173.78	Facility	26	$26.30	$123.03	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $660.69 / $1,513.56	Professional		$436.52	$660.69	$1,513.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $134.90 / $251.19	Professional	26	$89.13	$134.90	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $549.54 / $1,230.27	Professional	TC	$323.59	$549.54	$1,230.27
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $977.24 / $977.24 / $977.24	Facility	26	$977.24	$977.24	$977.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,165.95 / $6,165.95 / $6,165.95	Professional		$6,165.95	$6,165.95	$6,165.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $933.25 / $933.25 / $933.25	Professional	26	$933.25	$933.25	$933.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,623.41 / $5,623.41 / $5,623.41	Professional	TC	$5,623.41	$5,623.41	$5,623.41
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $138.04 / $165.96	Facility	26	$87.10	$138.04	$165.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $616.60 / $1,348.96	Professional		$426.58	$616.60	$1,348.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $154.88 / $309.03	Professional	26	$104.71	$154.88	$309.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $478.63 / $912.01	Professional	TC	$302.00	$478.63	$912.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $389.05	Professional		$32.36	$33.11	$389.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,122.02 / $1,584.89	Professional		$831.76	$1,122.02	$1,584.89
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $123.03 / $173.78	Facility	26	$26.30	$123.03	$173.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $676.08 / $1,412.54	Professional		$436.52	$676.08	$1,412.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $131.83 / $213.80	Professional	26	$91.20	$131.83	$213.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $512.86 / $1,174.90	Professional	TC	$323.59	$512.86	$1,174.90
United Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $676.08 / $1,258.93	Professional		$478.63	$676.08	$1,258.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $114.82 / $204.17	Professional	26	$91.20	$114.82	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $537.03 / $1,000.00	Professional	TC	$380.19	$537.03	$1,000.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $457.09 / $549.54	Professional		$436.52	$457.09	$549.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $104.71 / $125.89	Professional	26	$102.33	$104.71	$125.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $426.58	Professional	TC	$338.84	$338.84	$426.58