Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $650.23 / $2,000.00 / $6,762.00	Facility		$650.23	$2,000.00	$6,762.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $452.17 / $525.46 / $732.47	Facility	54	$452.17	$525.46	$732.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $517.96 / $708.44 / $1,049.10	Professional		$517.96	$708.44	$1,049.10
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $388.47 / $544.82 / $801.97	Professional	54	$388.47	$544.82	$801.97
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $77.69 / $108.96 / $160.38	Professional	55	$77.69	$108.96	$160.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $562.42 / $815.44 / $1,082.01	Professional		$562.42	$815.44	$1,082.01
BCBS Facility/Professional Facility Modifier Low / Median / High Price $758.55 / $1,315.36 / $2,735.63	Facility		$758.55	$1,315.36	$2,735.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $546.35 / $691.54 / $1,029.90	Professional		$546.35	$691.54	$1,029.90
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $618.66 / $770.62 / $1,113.41	Professional		$618.66	$770.62	$1,113.41
Christus Facility/Professional Facility Modifier Low / Median / High Price $510.76 / $510.76 / $708.38	Facility		$510.76	$510.76	$708.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $610.55 / $610.55 / $630.51	Facility		$610.55	$610.55	$630.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $588.47 / $777.29 / $1,129.16	Professional		$588.47	$777.29	$1,129.16
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $4,117.62 / $12,000.00 / $12,000.00	Facility		$4,117.62	$12,000.00	$12,000.00
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $1,866.51 / $2,152.54 / $2,152.54	Facility	54	$1,866.51	$2,152.54	$2,152.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,370.96 / $5,003.20 / $5,720.33	Professional		$4,370.96	$5,003.20	$5,720.33
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $574.26 / $731.16 / $1,113.43	Facility		$574.26	$731.16	$1,113.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $639.40 / $871.91 / $1,133.86	Professional		$639.40	$871.91	$1,133.86
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $537.36 / $664.27 / $752.33	Professional		$537.36	$664.27	$752.33
Providence Facility/Professional Facility Modifier Low / Median / High Price $574.26 / $737.51 / $1,191.85	Facility		$574.26	$737.51	$1,191.85
Providence Facility/Professional Professional Modifier Low / Median / High Price $597.04 / $799.31 / $1,226.61	Professional		$597.04	$799.31	$1,226.61
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $1,023.14 / $1,023.14 / $1,047.39	Professional	54	$1,023.14	$1,023.14	$1,047.39
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $255.78 / $255.78 / $261.85	Professional	55	$255.78	$255.78	$261.85
United Facility/Professional Facility Modifier Low / Median / High Price $597.00 / $2,054.00 / $4,509.00	Facility		$597.00	$2,054.00	$4,509.00
United Facility/Professional Professional Modifier Low / Median / High Price $525.38 / $700.50 / $1,032.24	Professional		$525.38	$700.50	$1,032.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $569.25 / $643.42 / $904.64	Professional		$569.25	$643.42	$904.64