Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.30 / $111.93 / $325.20	Facility		$83.30	$111.93	$325.20
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $132.57 / $374.55 / $780.91	Facility	25	$132.57	$374.55	$780.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.05 / $111.93 / $261.54	Professional		$70.05	$111.93	$261.54
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $62.28 / $134.07 / $353.00	Professional	25	$62.28	$134.07	$353.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $94.50 / $94.50 / $94.50	Professional	50	$94.50	$94.50	$94.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.01 / $117.93 / $150.32	Professional		$92.01	$117.93	$150.32
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $92.01 / $121.66 / $153.94	Professional	25	$92.01	$121.66	$153.94
BCBS Facility/Professional Facility Modifier Low / Median / High Price $80.01 / $136.24 / $295.24	Facility		$80.01	$136.24	$295.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.80 / $84.33 / $114.29	Professional		$64.80	$84.33	$114.29
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $78.01 / $97.17 / $194.66	Facility		$78.01	$97.17	$194.66
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $94.08 / $133.83 / $194.66	Professional		$94.08	$133.83	$194.66
Christus Facility/Professional Facility Modifier Low / Median / High Price $83.67 / $105.38 / $120.79	Facility		$83.67	$105.38	$120.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $155.00 / $235.00	Facility		$120.00	$155.00	$235.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.76 / $117.07 / $187.38	Professional		$81.76	$117.07	$187.38
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $124.21 / $475.57 / $475.57	Facility		$124.21	$475.57	$475.57
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $140.76 / $801.06 / $801.06	Professional		$140.76	$801.06	$801.06
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $73.94 / $109.09 / $174.51	Facility		$73.94	$109.09	$174.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $93.00 / $136.50 / $204.69	Professional		$93.00	$136.50	$204.69
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $92.42 / $142.19 / $545.37	Facility		$92.42	$142.19	$545.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $86.67 / $129.26 / $219.22	Professional		$86.67	$129.26	$219.22
Providence Facility/Professional Facility Modifier Low / Median / High Price $74.76 / $109.92 / $179.22	Facility		$74.76	$109.92	$179.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $78.84 / $123.56 / $238.95	Professional		$78.84	$123.56	$238.95
Providence Facility/Professional Professional Modifier 25 Low / Median / High Price $47.00 / $47.00 / $47.00	Professional	25	$47.00	$47.00	$47.00
United Facility/Professional Professional Modifier Low / Median / High Price $82.71 / $110.93 / $166.69	Professional		$82.71	$110.93	$166.69
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.84 / $125.27 / $170.32	Professional		$106.84	$125.27	$170.32