Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $199.53 / $316.23	Facility		$120.23	$199.53	$316.23
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $190.55 / $199.53 / $602.56	Facility	25	$190.55	$199.53	$602.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $120.23 / $229.09	Professional		$56.23	$120.23	$229.09
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $27.54 / $128.82 / $257.04	Professional	25	$27.54	$128.82	$257.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $123.03 / $158.49	Professional		$107.15	$123.03	$158.49
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $114.82 / $125.89 / $158.49	Professional	25	$114.82	$125.89	$158.49
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $199.53 / $407.38	Facility		$56.23	$199.53	$407.38
BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $102.33 / $154.88	Professional		$60.26	$102.33	$154.88
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $112.20 / $190.55	Professional		$67.61	$112.20	$190.55
Christus Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $109.65 / $123.03	Facility		$61.66	$109.65	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $114.82 / $190.55	Professional		$69.18	$114.82	$190.55
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $478.63 / $478.63	Facility		$478.63	$478.63	$478.63
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $181.97 / $1,023.29	Professional		$104.71	$181.97	$1,023.29
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $100.00 / $165.96	Facility		$56.23	$100.00	$165.96
Moda Health Facility/Professional Facility Modifier 25 Low / Median / High Price $190.55 / $199.53 / $602.56	Facility	25	$190.55	$199.53	$602.56
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $102.33 / $190.55	Professional		$58.88	$102.33	$190.55
Moda Health Facility/Professional Professional Modifier 25 Low / Median / High Price $44.67 / $125.89 / $263.03	Professional	25	$44.67	$125.89	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $60.26 / $104.71	Professional		$32.36	$60.26	$104.71
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $123.03 / $251.19	Professional		$61.66	$123.03	$251.19
Providence Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $100.00 / $165.96	Facility		$56.23	$100.00	$165.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $120.23 / $199.53	Professional		$72.44	$120.23	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $93.33 / $144.54	Professional		$60.26	$93.33	$144.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $79.43 / $128.82	Professional		$50.12	$79.43	$128.82