Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $275.42 / $281.84 / $309.03	Facility	26	$275.42	$281.84	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $2,041.74 / $5,370.32	Professional		$1,348.96	$2,041.74	$5,370.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $489.78 / $1,318.26	Professional	26	$302.00	$489.78	$1,318.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,047.13 / $1,548.82 / $2,754.23	Professional	TC	$1,047.13	$1,548.82	$2,754.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,819.70 / $2,454.71	Professional		$1,202.26	$1,819.70	$2,454.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $338.84 / $416.87 / $549.54	Professional	26	$338.84	$416.87	$549.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $1,445.44 / $2,041.74	Professional		$331.13	$1,445.44	$2,041.74
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $2,089.30 / $2,951.21	Professional		$1,698.24	$2,089.30	$2,951.21
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $398.11 / $426.58 / $426.58	Professional	26	$398.11	$426.58	$426.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $2,187.76 / $3,801.89	Professional		$1,621.81	$2,187.76	$3,801.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $354.81 / $489.78 / $831.76	Professional	26	$354.81	$489.78	$831.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,230.27 / $1,778.28 / $3,019.95	Professional	TC	$1,230.27	$1,778.28	$3,019.95
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2,630.27 / $2,630.27 / $2,630.27	Facility	26	$2,630.27	$2,630.27	$2,630.27
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $14,125.38 / $15,488.17 / $15,488.17	Professional		$14,125.38	$15,488.17	$15,488.17
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2,951.21 / $3,467.37 / $3,467.37	Professional	26	$2,951.21	$3,467.37	$3,467.37
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $8,912.51 / $12,302.69 / $12,302.69	Professional	TC	$8,912.51	$12,302.69	$12,302.69
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $281.84 / $281.84 / $309.03	Facility	26	$281.84	$281.84	$309.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $2,511.89 / $5,248.07	Professional		$1,348.96	$2,511.89	$5,248.07
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $575.44 / $1,096.48	Professional	26	$302.00	$575.44	$1,096.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $1,905.46 / $3,311.31	Professional	TC	$1,000.00	$1,905.46	$3,311.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $1,548.82	Professional		$32.36	$33.11	$1,548.82
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $2,951.21 / $3,548.13 / $3,890.45	Professional		$2,951.21	$3,548.13	$3,890.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $2,089.30 / $3,801.89	Professional		$1,621.81	$2,089.30	$3,801.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $354.81 / $478.63 / $812.83	Professional	26	$354.81	$478.63	$812.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,230.27 / $1,659.59 / $2,951.21	Professional	TC	$1,230.27	$1,659.59	$2,951.21
United Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $2,454.71 / $3,235.94	Professional		$1,659.59	$2,454.71	$3,235.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $363.08 / $478.63 / $707.95	Professional	26	$363.08	$478.63	$707.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,288.25 / $1,949.84 / $2,511.89	Professional	TC	$1,288.25	$1,949.84	$2,511.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $1,949.84	Professional		$1,862.09	$1,862.09	$1,949.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $407.38 / $407.38 / $426.58	Professional	26	$407.38	$407.38	$426.58
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $1,445.44 / $1,445.44 / $1,548.82	Professional	TC	$1,445.44	$1,445.44	$1,548.82