Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $131.83 / $407.38	Facility		$54.95	$131.83	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $77.62 / $208.93	Professional		$54.95	$77.62	$208.93
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	25	$120.23	$120.23	$120.23
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $57.54 / $57.54 / $57.54	Professional	CQ	$57.54	$57.54	$57.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $125.89	Professional		$93.33	$93.33	$125.89
BCBS Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $218.78 / $416.87	Facility		$87.10	$218.78	$416.87
BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $83.18 / $83.18	Professional		$74.13	$83.18	$83.18
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $120.23 / $218.78	Facility		$50.12	$120.23	$218.78
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $109.65 / $154.88	Professional		$87.10	$109.65	$154.88
Christus Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $97.72 / $97.72	Facility		$95.50	$97.72	$97.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $64.57 / $75.86	Facility		$54.95	$64.57	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $114.82	Professional		$57.54	$77.62	$114.82
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $630.96 / $630.96	Facility		$630.96	$630.96	$630.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $123.03 / $831.76	Professional		$97.72	$123.03	$831.76
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $91.20 / $234.42	Facility		$48.98	$91.20	$234.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $79.43 / $181.97	Professional		$50.12	$79.43	$181.97
Moda Health Facility/Professional Professional Modifier 25 Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	25	$120.23	$120.23	$120.23
Moda Health Facility/Professional Professional Modifier CQ Low / Median / High Price $57.54 / $57.54 / $57.54	Professional	CQ	$57.54	$57.54	$57.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $128.82	Professional		$32.36	$33.11	$128.82
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $245.47 / $263.03	Facility		$114.82	$245.47	$263.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $100.00 / $354.81	Professional		$89.13	$100.00	$354.81
Providence Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $89.13 / $154.88	Facility		$57.54	$89.13	$154.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $117.49	Professional		$57.54	$77.62	$117.49
United Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $107.15	Facility		$77.62	$77.62	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $74.13 / $109.65	Professional		$64.57	$74.13	$109.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $95.50 / $97.72	Professional		$69.18	$95.50	$97.72