Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $66.07 / $75.86	Facility	26	$60.26	$66.07	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $251.19 / $891.25	Professional		$134.90	$251.19	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $331.13	Professional	26	$69.18	$112.20	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $173.78 / $269.15	Professional		$138.04	$173.78	$269.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $93.33 / $141.25	Professional	26	$70.79	$93.33	$141.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $138.04 / $194.98	Professional		$72.44	$138.04	$194.98
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $234.42 / $331.13	Professional		$158.49	$234.42	$331.13
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $138.04 / $138.04	Professional	26	$83.18	$138.04	$138.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $102.33 / $144.54	Facility	26	$21.88	$102.33	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $204.17 / $380.19	Professional		$144.54	$204.17	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $100.00 / $190.55	Professional	26	$74.13	$100.00	$190.55
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $575.44 / $575.44 / $575.44	Facility	26	$575.44	$575.44	$575.44
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,479.11 / $1,513.56	Professional		$1,479.11	$1,479.11	$1,513.56
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $630.96 / $707.95 / $707.95	Professional	26	$630.96	$707.95	$707.95
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $66.07 / $75.86	Facility	26	$54.95	$66.07	$75.86
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $234.42 / $562.34	Professional		$141.25	$234.42	$562.34
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $114.82 / $263.03	Professional	26	$70.79	$114.82	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $75.86 / $154.88	Professional		$32.36	$75.86	$154.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $181.97 / $398.11	Professional		$89.13	$181.97	$398.11
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $102.33 / $144.54	Facility	26	$21.88	$102.33	$144.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $194.98 / $398.11	Professional		$147.91	$194.98	$398.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $95.50 / $177.83	Professional	26	$74.13	$95.50	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $194.98 / $309.03	Professional		$154.88	$194.98	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $100.00 / $154.88	Professional	26	$77.62	$100.00	$154.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $181.97 / $218.78	Professional		$173.78	$181.97	$218.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $91.20 / $109.65	Professional	26	$91.20	$91.20	$109.65