Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $151.36 / $407.38	Facility		$104.71	$151.36	$407.38
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $229.09 / $346.74 / $891.25	Facility	25	$229.09	$346.74	$891.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $169.82 / $398.11	Professional		$107.15	$169.82	$398.11
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $120.23 / $194.98 / $467.74	Professional	25	$120.23	$194.98	$467.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $162.18 / $213.80	Professional		$117.49	$162.18	$213.80
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $128.82 / $162.18 / $208.93	Professional	25	$128.82	$162.18	$208.93
BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $144.54 / $489.78	Facility		$83.18	$144.54	$489.78
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $128.82 / $162.18	Professional		$107.15	$128.82	$162.18
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $218.78 / $275.42	Facility		$218.78	$218.78	$275.42
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $181.97 / $316.23	Professional		$123.03	$181.97	$316.23
Christus Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $134.90 / $173.78	Facility		$114.82	$134.90	$173.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $173.78 / $234.42	Facility		$125.89	$173.78	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $173.78 / $288.40	Professional		$128.82	$173.78	$288.40
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $831.76 / $831.76	Facility		$169.82	$831.76	$831.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $194.98 / $1,047.13	Professional		$154.88	$194.98	$1,047.13
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $173.78 / $295.12	Facility		$112.20	$173.78	$295.12
Moda Health Facility/Professional Facility Modifier 25 Low / Median / High Price $229.09 / $323.59 / $891.25	Facility	25	$229.09	$323.59	$891.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $151.36 / $288.40	Professional		$104.71	$151.36	$288.40
Moda Health Facility/Professional Professional Modifier 25 Low / Median / High Price $120.23 / $194.98 / $478.63	Professional	25	$120.23	$194.98	$478.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $53.70 / $95.50	Professional		$32.36	$53.70	$95.50
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $288.40 / $380.19	Facility		$147.91	$288.40	$380.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $269.15 / $630.96	Professional		$123.03	$269.15	$630.96
Providence Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $173.78 / $288.40	Facility		$112.20	$173.78	$288.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $173.78 / $323.59	Professional		$125.89	$173.78	$323.59
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $131.83 / $173.78	Facility		$69.18	$131.83	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $229.09	Professional		$112.20	$151.36	$229.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $169.82 / $194.98	Professional		$102.33	$169.82	$194.98