Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $246.88 / $1,871.00 / $6,021.00	Facility		$246.88	$1,871.00	$6,021.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $132.13 / $152.29 / $247.57	Facility	54	$132.13	$152.29	$247.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $176.18 / $211.78 / $372.70	Professional		$176.18	$211.78	$372.70
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $140.76 / $161.75 / $263.20	Professional	54	$140.76	$161.75	$263.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $193.79 / $243.43 / $279.42	Professional		$193.79	$243.43	$279.42
Ambetter Facility/Professional Professional Modifier 54 Low / Median / High Price $428.60 / $428.60 / $428.60	Professional	54	$428.60	$428.60	$428.60
BCBS Facility/Professional Facility Modifier Low / Median / High Price $95.88 / $166.71 / $666.84	Facility		$95.88	$166.71	$666.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $191.76 / $240.07 / $338.16	Professional		$191.76	$240.07	$338.16
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $195.16 / $238.52 / $315.33	Facility		$195.16	$238.52	$315.33
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $224.91 / $294.06 / $373.23	Professional		$224.91	$294.06	$373.23
Christus Facility/Professional Facility Modifier Low / Median / High Price $202.04 / $224.51 / $224.51	Facility		$202.04	$224.51	$224.51
Cigna Facility/Professional Facility Modifier Low / Median / High Price $351.09 / $351.09 / $351.09	Facility		$351.09	$351.09	$351.09
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $245.76 / $245.76 / $245.76	Facility	54	$245.76	$245.76	$245.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $210.83 / $274.58 / $425.23	Professional		$210.83	$274.58	$425.23
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $55.00 / $1,110.50	Facility		$55.00	$55.00	$1,110.50
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $681.37 / $777.35 / $777.35	Facility	54	$681.37	$777.35	$777.35
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,543.44 / $1,670.64 / $1,909.88	Professional		$1,543.44	$1,670.64	$1,909.88
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $193.47 / $250.30 / $395.85	Facility		$193.47	$250.30	$395.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $258.39 / $311.99 / $393.20	Professional		$258.39	$311.99	$393.20
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $237.04 / $386.59 / $810.73	Professional		$237.04	$386.59	$810.73
Providence Facility/Professional Facility Modifier Low / Median / High Price $194.46 / $252.94 / $406.50	Facility		$194.46	$252.94	$406.50
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $245.76 / $245.76 / $418.20	Facility	54	$245.76	$245.76	$418.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.86 / $289.52 / $444.46	Professional		$213.86	$289.52	$444.46
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $328.10 / $344.30 / $406.22	Professional	54	$328.10	$344.30	$406.22
United Facility/Professional Facility Modifier Low / Median / High Price $161.00 / $943.00 / $2,376.00	Facility		$161.00	$943.00	$2,376.00
United Facility/Professional Professional Modifier Low / Median / High Price $170.10 / $233.18 / $359.33	Professional		$170.10	$233.18	$359.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $188.00 / $211.68 / $298.23	Professional		$188.00	$211.68	$298.23