Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $67.61 / $97.72	Facility	26	$60.26	$67.61	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $165.96 / $288.40	Professional		$141.25	$165.96	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $72.44 / $208.93	Professional	26	$61.66	$72.44	$208.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $147.91 / $199.53	Professional		$131.83	$147.91	$199.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $79.43 / $123.03	Professional	26	$67.61	$79.43	$123.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $120.23 / $213.80	Professional		$61.66	$120.23	$213.80
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $186.21 / $234.42	Professional		$151.36	$186.21	$234.42
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $67.61 / $67.61	Professional	26	$63.10	$67.61	$67.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $109.65	Facility	26	$16.22	$75.86	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $199.53 / $323.59	Professional		$147.91	$199.53	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $141.25	Professional	26	$66.07	$87.10	$141.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,288.25 / $1,288.25	Professional		$977.24	$1,288.25	$1,288.25
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $426.58 / $537.03 / $537.03	Professional	26	$426.58	$537.03	$537.03
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $67.61 / $97.72	Facility	26	$51.29	$67.61	$97.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $173.78 / $316.23	Professional		$141.25	$173.78	$316.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $75.86 / $162.18	Professional	26	$61.66	$75.86	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $51.29 / $125.89	Professional		$32.36	$51.29	$125.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $169.82 / $363.08	Professional		$74.13	$169.82	$363.08
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $199.53 / $346.74	Professional		$147.91	$199.53	$346.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $85.11 / $131.83	Professional	26	$66.07	$85.11	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $169.82 / $263.03	Professional		$128.82	$169.82	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $74.13 / $114.82	Professional	26	$56.23	$74.13	$114.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $158.49 / $199.53	Professional		$120.23	$158.49	$199.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $66.07 / $83.18	Professional	26	$51.29	$66.07	$83.18