Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $125.89 / $229.09	Facility	26	$114.82	$125.89	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $724.44 / $1,230.27	Professional		$575.44	$724.44	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $144.54 / $457.09	Professional	26	$114.82	$144.54	$457.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $190.55 / $213.80 / $1,258.93	Professional	52	$190.55	$213.80	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $575.44 / $954.99	Professional	TC	$446.68	$575.44	$954.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $645.65 / $1,071.52	Professional		$549.54	$645.65	$1,071.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $125.89 / $158.49	Professional	26	$112.20	$125.89	$158.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $489.78 / $575.44	Professional	TC	$323.59	$489.78	$575.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $478.63 / $812.83	Professional		$97.72	$478.63	$812.83
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $707.95 / $1,047.13	Professional		$407.38	$707.95	$1,047.13
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $125.89 / $125.89	Professional	26	$123.03	$125.89	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $891.25 / $1,445.44	Professional		$630.96	$891.25	$1,445.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $169.82 / $309.03	Professional	26	$120.23	$169.82	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $691.83 / $1,122.02	Professional	TC	$501.19	$691.83	$1,122.02
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $6,165.95 / $6,165.95	Professional		$562.34	$6,165.95	$6,165.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Professional	26	$1,071.52	$1,071.52	$1,071.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,981.07 / $4,570.88 / $4,570.88	Professional	TC	$3,981.07	$4,570.88	$4,570.88
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $123.03 / $158.49	Facility	26	$100.00	$123.03	$158.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $776.25 / $1,318.26	Professional		$575.44	$776.25	$1,318.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $141.25 / $281.84	Professional	26	$114.82	$141.25	$281.84
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $190.55 / $199.53 / $512.86	Professional	52	$190.55	$199.53	$512.86
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $616.60 / $1,071.52	Professional	TC	$457.09	$616.60	$1,071.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $549.54	Professional		$32.36	$33.11	$549.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $1,513.56 / $2,570.40	Professional		$457.09	$1,513.56	$2,570.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $891.25 / $1,584.89	Professional		$630.96	$891.25	$1,584.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $169.82 / $288.40	Professional	26	$120.23	$169.82	$288.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $691.83 / $1,096.48	Professional	TC	$501.19	$691.83	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $741.31 / $1,258.93	Professional		$549.54	$741.31	$1,258.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $141.25 / $251.19	Professional	26	$104.71	$141.25	$251.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $588.84 / $1,023.29	Professional	TC	$446.68	$588.84	$1,023.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $707.95 / $851.14	Professional		$501.19	$707.95	$851.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $125.89 / $151.36	Professional	26	$93.33	$125.89	$151.36
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $575.44 / $691.83	Professional	TC	$407.38	$575.44	$691.83