Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $165.36 / $799.00 / $4,449.00	Facility		$165.36	$799.00	$4,449.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $60.32 / $72.50 / $125.19	Facility	54	$60.32	$72.50	$125.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.58 / $112.52 / $207.15	Professional		$82.58	$112.52	$207.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.16 / $125.21 / $173.70	Professional		$101.16	$125.21	$173.70
BCBS Facility/Professional Facility Modifier Low / Median / High Price $64.06 / $107.11 / $420.15	Facility		$64.06	$107.11	$420.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.24 / $118.85 / $170.44	Professional		$88.24	$118.85	$170.44
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $50.27 / $74.50 / $225.20	Facility		$50.27	$74.50	$225.20
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $68.23 / $107.55 / $182.09	Professional		$68.23	$107.55	$182.09
Christus Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $160.25 / $160.25	Facility		$97.72	$160.25	$160.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.77 / $137.62 / $200.49	Professional		$106.77	$137.62	$200.49
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $55.00 / $555.85	Facility		$55.00	$55.00	$555.85
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $343.32 / $389.09 / $389.09	Facility	54	$343.32	$389.09	$389.09
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $782.96 / $926.08 / $1,071.75	Professional		$782.96	$926.08	$1,071.75
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $95.24 / $124.07 / $186.11	Facility		$95.24	$124.07	$186.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $111.65 / $160.34 / $217.55	Professional		$111.65	$160.34	$217.55
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $662.00 / $879.00 / $1,418.00	Facility		$662.00	$879.00	$1,418.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $101.16 / $124.38 / $155.94	Professional		$101.16	$124.38	$155.94
Providence Facility/Professional Facility Modifier Low / Median / High Price $94.70 / $121.83 / $172.19	Facility		$94.70	$121.83	$172.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $107.70 / $145.72 / $228.10	Professional		$107.70	$145.72	$228.10
United Facility/Professional Facility Modifier Low / Median / High Price $161.00 / $1,058.00 / $2,668.00	Facility		$161.00	$1,058.00	$2,668.00
United Facility/Professional Professional Modifier Low / Median / High Price $91.26 / $124.15 / $180.80	Professional		$91.26	$124.15	$180.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.01 / $119.50 / $167.30	Professional		$106.01	$119.50	$167.30