Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.81 / $122.20 / $176.74	Facility	26	$94.81	$122.20	$176.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $528.15 / $710.62 / $1,115.74	Professional		$528.15	$710.62	$1,115.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.31 / $134.41 / $243.52	Professional	26	$106.31	$134.41	$243.52
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.77 / $332.74 / $467.76	Professional	52	$258.77	$332.74	$467.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $416.39 / $552.50 / $822.51	Professional	TC	$416.39	$552.50	$822.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $598.42 / $606.71 / $772.18	Professional		$598.42	$606.71	$772.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $104.29 / $117.83 / $148.91	Professional	26	$104.29	$117.83	$148.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $516.04 / $516.04 / $516.04	Professional	TC	$516.04	$516.04	$516.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.37 / $450.44 / $840.31	Professional		$96.37	$450.44	$840.31
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $628.04 / $763.49 / $1,115.89	Professional		$628.04	$763.49	$1,115.89
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $114.07 / $126.49 / $126.49	Professional	26	$114.07	$126.49	$126.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $637.04 / $882.38 / $1,397.00	Professional		$637.04	$882.38	$1,397.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $121.10 / $170.46 / $309.22	Professional	26	$121.10	$170.46	$309.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $511.75 / $694.58 / $1,086.75	Professional	TC	$511.75	$694.58	$1,086.75
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $288.64 / $753.90 / $753.90	Facility	26	$288.64	$753.90	$753.90
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 $1,081.48 / $1,081.48 / $1,081.48	Professional	26	$1,081.48	$1,081.48	$1,081.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,875.48 / $3,991.74 / $4,567.58	Professional	TC	$3,875.48	$3,991.74	$4,567.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $532.78 / $892.12 / $1,235.04	Professional		$532.78	$892.12	$1,235.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $137.35 / $179.15 / $217.79	Professional	26	$137.35	$179.15	$217.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $610.11 / $795.80 / $967.44	Professional	TC	$610.11	$795.80	$967.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $152.19 / $754.95 / $1,411.94	Professional		$152.19	$754.95	$1,411.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $654.54 / $933.26 / $1,650.88	Professional		$654.54	$933.26	$1,650.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $121.11 / $169.63 / $301.56	Professional	26	$121.11	$169.63	$301.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $513.32 / $698.27 / $1,074.55	Professional	TC	$513.32	$698.27	$1,074.55
United Facility/Professional Professional Modifier Low / Median / High Price $521.15 / $721.11 / $1,263.60	Professional		$521.15	$721.11	$1,263.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $103.36 / $142.12 / $250.38	Professional	26	$103.36	$142.12	$250.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $415.75 / $579.17 / $1,013.58	Professional	TC	$415.75	$579.17	$1,013.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $543.86 / $636.24 / $865.26	Professional		$543.86	$636.24	$865.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $99.93 / $117.64 / $159.07	Professional	26	$99.93	$117.64	$159.07
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $443.92 / $518.59 / $706.19	Professional	TC	$443.92	$518.59	$706.19