Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.99 / $1,508.00 / $5,872.00	Facility		$91.99	$1,508.00	$5,872.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $990.08 / $1,184.23 / $2,712.44	Facility	50	$990.08	$1,184.23	$2,712.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.70 / $89.62 / $160.62	Professional		$55.70	$89.62	$160.62
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $84.00 / $168.29 / $580.50	Professional	50	$84.00	$168.29	$580.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.09 / $92.99 / $119.00	Professional		$65.09	$92.99	$119.00
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $103.36 / $139.49 / $181.33	Professional	50	$103.36	$139.49	$181.33
BCBS Facility/Professional Facility Modifier Low / Median / High Price $47.88 / $67.16 / $250.89	Facility		$47.88	$67.16	$250.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.41 / $85.22 / $131.59	Professional		$54.41	$85.22	$131.59
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $58.43 / $89.02 / $102.93	Facility		$58.43	$89.02	$102.93
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $65.69 / $110.60 / $159.66	Professional		$65.69	$110.60	$159.66
Christus Facility/Professional Facility Modifier Low / Median / High Price $49.40 / $298.35 / $298.35	Facility		$49.40	$298.35	$298.35
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.78 / $100.78 / $100.78	Facility		$100.78	$100.78	$100.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.54 / $106.56 / $174.85	Professional		$65.54	$106.56	$174.85
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $55.00 / $286.62	Facility		$55.00	$55.00	$286.62
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $426.40 / $492.75 / $835.05	Professional		$426.40	$492.75	$835.05
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $57.12 / $95.26 / $154.44	Facility		$57.12	$95.26	$154.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $74.43 / $125.31 / $194.60	Professional		$74.43	$125.31	$194.60
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $164.66 / $201.54 / $357.75	Professional	50	$164.66	$201.54	$357.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $55.22 / $100.50 / $192.32	Professional		$55.22	$100.50	$192.32
Providence Facility/Professional Facility Modifier Low / Median / High Price $57.42 / $96.16 / $159.55	Facility		$57.42	$96.16	$159.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.09 / $111.08 / $185.85	Professional		$66.09	$111.08	$185.85
United Facility/Professional Facility Modifier Low / Median / High Price $161.00 / $950.00 / $2,405.00	Facility		$161.00	$950.00	$2,405.00
United Facility/Professional Professional Modifier Low / Median / High Price $75.09 / $100.13 / $160.12	Professional		$75.09	$100.13	$160.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $82.27 / $92.99 / $130.33	Professional		$82.27	$92.99	$130.33