Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $109.65 / $144.54	Facility		$104.71	$109.65	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $120.23 / $165.96	Professional		$102.33	$120.23	$165.96
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $117.49 / $125.89 / $169.82	Professional	25	$117.49	$125.89	$169.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $131.83 / $154.88	Professional		$117.49	$131.83	$154.88
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $112.20 / $123.03 / $154.88	Professional	25	$112.20	$123.03	$154.88
BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,162.28 / $3,548.13 / $4,265.80	Facility		$3,162.28	$3,548.13	$4,265.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $125.89 / $147.91	Professional		$112.20	$125.89	$147.91
Christus Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Facility		$128.82	$128.82	$128.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Facility		$93.33	$93.33	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $151.36 / $199.53	Professional		$123.03	$151.36	$199.53
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $831.76 / $831.76	Facility		$831.76	$831.76	$831.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $870.96 / $870.96	Professional		$870.96	$870.96	$870.96
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $109.65 / $165.96	Facility		$104.71	$109.65	$165.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $123.03 / $204.17	Professional		$104.71	$123.03	$204.17
Moda Health Facility/Professional Professional Modifier 25 Low / Median / High Price $117.49 / $138.04 / $263.03	Professional	25	$117.49	$138.04	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $173.78	Professional		$32.36	$33.11	$173.78
Providence Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $162.18 / $208.93	Facility		$138.04	$162.18	$208.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $199.53	Professional		$114.82	$151.36	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $138.04 / $181.97	Professional		$102.33	$138.04	$181.97