Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $1,949.84 / $5,128.61	Facility		$575.44	$1,949.84	$5,128.61
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,513.56 / $2,570.40 / $4,897.79	Facility	50	$1,513.56	$2,570.40	$4,897.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $229.09 / $602.56	Professional		$104.71	$229.09	$602.56
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $812.83 / $812.83 / $1,230.27	Professional	22	$812.83	$812.83	$1,230.27
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $154.88 / $398.11 / $1,348.96	Professional	50	$154.88	$398.11	$1,348.96
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $51.29 / $125.89 / $186.21	Professional	53	$51.29	$125.89	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $147.91 / $295.12	Professional		$97.72	$147.91	$295.12
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $154.88 / $323.59 / $457.09	Professional	50	$154.88	$323.59	$457.09
BCBS Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $1,288.25 / $2,570.40	Facility		$707.95	$1,288.25	$2,570.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $177.83 / $309.03	Professional		$91.20	$177.83	$309.03
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $891.25 / $3,715.35	Facility		$109.65	$891.25	$3,715.35
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $169.82 / $389.05	Professional		$91.20	$169.82	$389.05
Christus Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $724.44 / $724.44	Facility		$97.72	$724.44	$724.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $229.09 / $436.52	Professional		$120.23	$229.09	$436.52
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $32,359.37 / $32,359.37	Facility		$2,691.53	$32,359.37	$32,359.37
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $537.03 / $537.03 / $537.03	Facility	53	$537.03	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,073.80 / $4,073.80 / $4,073.80	Professional		$4,073.80	$4,073.80	$4,073.80
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $323.59 / $2,570.40	Facility		$112.20	$323.59	$2,570.40
Moda Health Facility/Professional Facility Modifier 50 Low / Median / High Price $1,479.11 / $2,454.71 / $5,754.40	Facility	50	$1,479.11	$2,454.71	$5,754.40
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $229.09 / $489.78	Professional		$104.71	$229.09	$489.78
Moda Health Facility/Professional Professional Modifier 22 Low / Median / High Price $812.83 / $812.83 / $1,230.27	Professional	22	$812.83	$812.83	$1,230.27
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $165.96 / $380.19 / $1,174.90	Professional	50	$165.96	$380.19	$1,174.90
Moda Health Facility/Professional Professional Modifier 53 Low / Median / High Price $51.29 / $97.72 / $186.21	Professional	53	$51.29	$97.72	$186.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $208.93	Professional		$32.36	$33.11	$208.93
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $2,511.89 / $3,388.44	Facility		$2,137.96	$2,511.89	$3,388.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $371.54 / $977.24	Professional		$288.40	$371.54	$977.24
Providence Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $251.19 / $489.78	Facility		$107.15	$251.19	$489.78
Providence Facility/Professional Facility Modifier 22 Low / Median / High Price $223.87 / $223.87 / $223.87	Facility	22	$223.87	$223.87	$223.87
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $38.02 / $38.02 / $38.02	Facility	53	$38.02	$38.02	$38.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $229.09 / $446.68	Professional		$117.49	$229.09	$446.68
United Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $1,698.24 / $4,168.69	Facility		$436.52	$1,698.24	$4,168.69
United Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $186.21 / $363.08	Professional		$97.72	$186.21	$363.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $269.15 / $269.15	Professional		$251.19	$269.15	$269.15