Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $85.11 / $87.10	Facility	26	$70.79	$85.11	$87.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $309.03 / $616.60	Professional		$218.78	$309.03	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $95.50 / $229.09	Professional	26	$66.07	$95.50	$229.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $131.83 / $263.03	Professional		$131.83	$131.83	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $81.28 / $154.88	Professional	26	$64.57	$81.28	$154.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $208.93 / $288.40	Professional		$70.79	$208.93	$288.40
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $323.59 / $398.11	Professional		$288.40	$323.59	$398.11
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $77.62 / $85.11	Professional	26	$77.62	$77.62	$85.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $389.05 / $794.33	Professional		$257.04	$389.05	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $95.50 / $186.21	Professional	26	$70.79	$95.50	$186.21
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 $2,951.21 / $2,951.21 / $2,951.21	Professional		$2,951.21	$2,951.21	$2,951.21
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $537.03 / $676.08 / $676.08	Professional	26	$537.03	$676.08	$676.08
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $74.13 / $87.10	Facility	26	$70.79	$74.13	$87.10
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $363.08 / $741.31	Professional		$239.88	$363.08	$741.31
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $104.71 / $223.87	Professional	26	$70.79	$104.71	$223.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $245.47	Professional		$32.36	$33.11	$245.47
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $275.42 / $602.56	Professional		$87.10	$275.42	$602.56
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $389.05 / $776.25	Professional		$257.04	$389.05	$776.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $89.13 / $165.96	Professional	26	$70.79	$89.13	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $380.19 / $660.69	Professional		$281.84	$380.19	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $91.20 / $162.18	Professional	26	$74.13	$91.20	$162.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $263.03 / $316.23	Professional		$251.19	$263.03	$316.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $85.11 / $100.00	Professional	26	$81.28	$85.11	$100.00