Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $69.18 / $134.90	Facility	26	$58.88	$69.18	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $169.82 / $316.23	Professional		$117.49	$169.82	$316.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $204.17	Professional	26	$54.95	$83.18	$204.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $75.86 / $173.78	Professional	26	$56.23	$75.86	$173.78
BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $131.83 / $199.53	Professional		$72.44	$131.83	$199.53
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $199.53 / $281.84	Professional		$147.91	$199.53	$281.84
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $93.33 / $93.33	Professional	26	$89.13	$93.33	$93.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $107.15 / $154.88	Facility	26	$22.91	$107.15	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $223.87 / $602.56	Professional		$128.82	$223.87	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $85.11 / $169.82	Professional	26	$51.29	$85.11	$169.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $588.84 / $588.84 / $588.84	Facility	26	$588.84	$588.84	$588.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,162.28 / $3,162.28 / $3,162.28	Professional		$3,162.28	$3,162.28	$3,162.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $676.08 / $758.58 / $758.58	Professional	26	$676.08	$758.58	$758.58
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $67.61 / $134.90	Facility	26	$58.88	$67.61	$134.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $208.93 / $416.87	Professional		$125.89	$208.93	$416.87
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $97.72 / $204.17	Professional	26	$56.23	$97.72	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $134.90	Professional		$32.36	$33.11	$134.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $407.38 / $1,000.00	Professional		$295.12	$407.38	$1,000.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $107.15 / $154.88	Facility	26	$22.91	$107.15	$154.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $223.87 / $524.81	Professional		$131.83	$223.87	$524.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $83.18 / $151.36	Professional	26	$48.98	$83.18	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $199.53 / $389.05	Professional		$141.25	$199.53	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $79.43 / $131.83	Professional	26	$51.29	$79.43	$131.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $169.82 / $204.17	Professional		$162.18	$169.82	$204.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $93.33 / $112.20	Professional	26	$89.13	$93.33	$112.20