Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.35 / $120.68 / $169.53	Facility	26	$91.35	$120.68	$169.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $505.93 / $679.75 / $1,065.40	Professional		$505.93	$679.75	$1,065.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.44 / $129.85 / $275.51	Professional	26	$102.44	$129.85	$275.51
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $247.60 / $318.38 / $440.30	Professional	52	$247.60	$318.38	$440.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $395.30 / $525.21 / $792.54	Professional	TC	$395.30	$525.21	$792.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $571.29 / $579.34 / $737.16	Professional		$571.29	$579.34	$737.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $102.75 / $113.02 / $143.63	Professional	26	$102.75	$113.02	$143.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $492.29 / $492.29 / $492.29	Professional	TC	$492.29	$492.29	$492.29
BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.89 / $430.52 / $803.14	Professional		$92.89	$430.52	$803.14
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $450.00 / $698.66 / $1,068.11	Professional		$450.00	$698.66	$1,068.11
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $109.36 / $164.51 / $164.51	Professional	26	$109.36	$164.51	$164.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $602.02 / $823.33 / $1,311.72	Professional		$602.02	$823.33	$1,311.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.68 / $163.97 / $287.75	Professional	26	$116.68	$163.97	$287.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $485.88 / $663.70 / $1,021.01	Professional	TC	$485.88	$663.70	$1,021.01
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $275.57 / $701.13 / $701.13	Facility	26	$275.57	$701.13	$701.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,200.00 / $6,200.00 / $6,200.00	Professional		$6,200.00	$6,200.00	$6,200.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2,600.00 / $2,600.00 / $2,600.00	Professional	26	$2,600.00	$2,600.00	$2,600.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $7,000.00 / $7,000.00 / $7,000.00	Professional	TC	$7,000.00	$7,000.00	$7,000.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $480.48 / $833.29 / $1,177.38	Professional		$480.48	$833.29	$1,177.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.66 / $171.73 / $208.77	Professional	26	$131.66	$171.73	$208.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $582.04 / $759.19 / $922.93	Professional	TC	$582.04	$759.19	$922.93
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $148.88 / $733.91 / $1,390.14	Professional		$148.88	$733.91	$1,390.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $620.66 / $892.76 / $1,571.94	Professional		$620.66	$892.76	$1,571.94
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $116.68 / $163.33 / $281.17	Professional	26	$116.68	$163.33	$281.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $489.79 / $663.70 / $1,010.17	Professional	TC	$489.79	$663.70	$1,010.17
United Facility/Professional Professional Modifier Low / Median / High Price $498.51 / $702.57 / $1,169.99	Professional		$498.51	$702.57	$1,169.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.16 / $136.96 / $237.05	Professional	26	$99.16	$136.96	$237.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $397.78 / $551.04 / $916.92	Professional	TC	$397.78	$551.04	$916.92
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $519.29 / $607.53 / $826.21	Professional		$519.29	$607.53	$826.21
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $95.79 / $112.82 / $152.58	Professional	26	$95.79	$112.82	$152.58
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $423.49 / $494.71 / $673.65	Professional	TC	$423.49	$494.71	$673.65