Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.08 / $102.75 / $125.81	Facility	26	$86.08	$102.75	$125.81
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $122.29 / $144.46 / $164.60	Facility	53	$122.29	$144.46	$164.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $641.62 / $865.80 / $1,760.24	Professional		$641.62	$865.80	$1,760.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.97 / $132.47 / $458.28	Professional	26	$100.97	$132.47	$458.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $316.98 / $392.81 / $566.40	Professional	52	$316.98	$392.81	$566.40
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $126.79 / $157.12 / $226.56	Professional	53	$126.79	$157.12	$226.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $533.63 / $700.56 / $1,108.33	Professional	TC	$533.63	$700.56	$1,108.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $449.76 / $514.01 / $815.35	Professional		$449.76	$514.01	$815.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $73.39 / $89.11 / $129.04	Professional	26	$73.39	$89.11	$129.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.42 / $555.55 / $1,177.91	Professional		$99.42	$555.55	$1,177.91
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $656.00 / $748.48 / $1,188.64	Professional		$656.00	$748.48	$1,188.64
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $115.49 / $129.02 / $129.02	Professional	26	$115.49	$129.02	$129.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $712.24 / $1,068.71 / $1,733.58	Professional		$712.24	$1,068.71	$1,733.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.23 / $183.54 / $331.35	Professional	26	$110.23	$183.54	$331.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $596.79 / $867.93 / $1,416.17	Professional	TC	$596.79	$867.93	$1,416.17
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $259.19 / $789.30 / $789.30	Facility	26	$259.19	$789.30	$789.30
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $271.97 / $754.92 / $754.92	Facility	53	$271.97	$754.92	$754.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,332.25 / $5,492.22 / $5,862.60	Professional		$5,332.25	$5,492.22	$5,862.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $942.99 / $1,044.83 / $1,044.83	Professional	26	$942.99	$1,044.83	$1,044.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $4,416.72 / $4,549.22 / $4,976.85	Professional	TC	$4,416.72	$4,549.22	$4,976.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $844.65 / $1,114.94 / $2,702.88	Professional		$844.65	$1,114.94	$2,702.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $138.76 / $176.12 / $426.96	Professional	26	$138.76	$176.12	$426.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $739.66 / $938.80 / $2,275.88	Professional	TC	$739.66	$938.80	$2,275.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $122.09 / $927.00 / $1,823.20	Professional		$122.09	$927.00	$1,823.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $731.22 / $1,146.68 / $2,052.16	Professional		$731.22	$1,146.68	$2,052.16
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $114.08 / $185.26 / $331.35	Professional	26	$114.08	$185.26	$331.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $599.35 / $876.57 / $1,372.19	Professional	TC	$599.35	$876.57	$1,372.19
United Facility/Professional Professional Modifier Low / Median / High Price $703.60 / $944.86 / $1,574.77	Professional		$703.60	$944.86	$1,574.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.28 / $171.72 / $290.01	Professional	26	$112.28	$171.72	$290.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $597.92 / $786.81 / $1,270.59	Professional	TC	$597.92	$786.81	$1,270.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $576.71 / $642.51 / $918.59	Professional		$576.71	$642.51	$918.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $91.10 / $104.84 / $145.16	Professional	26	$91.10	$104.84	$145.16
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $485.60 / $537.67 / $773.44	Professional	TC	$485.60	$537.67	$773.44