Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $945.00 / $3,792.00 / $12,281.00	Facility		$945.00	$3,792.00	$12,281.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $10,481.94 / $10,481.94 / $38,444.91	Facility	50	$10,481.94	$10,481.94	$38,444.91
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $558.11 / $602.73 / $831.83	Facility	54	$558.11	$602.73	$831.83
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $111.62 / $120.55 / $166.37	Facility	55	$111.62	$120.55	$166.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $741.17 / $906.41 / $1,749.74	Professional		$741.17	$906.41	$1,749.74
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $523.58 / $675.86 / $1,065.28	Professional	54	$523.58	$675.86	$1,065.28
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $104.72 / $135.82 / $194.44	Professional	55	$104.72	$135.82	$194.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $540.77 / $734.78 / $1,330.68	Professional		$540.77	$734.78	$1,330.68
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,844.25 / $3,174.32 / $6,490.17	Facility		$1,844.25	$3,174.32	$6,490.17
BCBS Facility/Professional Professional Modifier Low / Median / High Price $586.00 / $701.14 / $1,134.78	Professional		$586.00	$701.14	$1,134.78
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $1,200.00 / $2,246.46 / $6,108.74	Facility		$1,200.00	$2,246.46	$6,108.74
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $394.65 / $730.43 / $1,193.57	Professional		$394.65	$730.43	$1,193.57
Christus Facility/Professional Facility Modifier Low / Median / High Price $617.63 / $1,712.13 / $1,712.13	Facility		$617.63	$1,712.13	$1,712.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,494.86 / $1,494.86 / $1,543.72	Facility		$1,494.86	$1,494.86	$1,543.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $730.70 / $965.87 / $1,686.59	Professional		$730.70	$965.87	$1,686.59
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $6,887.55 / $26,542.00 / $26,542.00	Facility		$6,887.55	$26,542.00	$26,542.00
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $1,198.40 / $4,569.92 / $4,569.92	Facility	54	$1,198.40	$4,569.92	$4,569.92
Lucent Health Facility/Professional Facility Modifier 55 Low / Median / High Price $256.80 / $979.27 / $979.27	Facility	55	$256.80	$979.27	$979.27
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,925.00 / $6,925.00 / $6,925.00	Professional		$6,925.00	$6,925.00	$6,925.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $728.78 / $1,080.13 / $1,752.21	Facility		$728.78	$1,080.13	$1,752.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $785.98 / $1,071.80 / $1,423.89	Professional		$785.98	$1,071.80	$1,423.89
Moda Health Facility/Professional Professional Modifier 54 Low / Median / High Price $573.45 / $573.45 / $710.31	Professional	54	$573.45	$573.45	$710.31
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $321.95 / $2,499.00 / $5,466.00	Facility		$321.95	$2,499.00	$5,466.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $628.78 / $759.04 / $1,340.70	Professional		$628.78	$759.04	$1,340.70
Providence Facility/Professional Facility Modifier Low / Median / High Price $728.78 / $1,086.98 / $1,974.31	Facility		$728.78	$1,086.98	$1,974.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $739.08 / $995.09 / $1,672.50	Professional		$739.08	$995.09	$1,672.50
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $1,090.94 / $1,090.94 / $1,116.81	Professional	54	$1,090.94	$1,090.94	$1,116.81
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $272.73 / $272.73 / $279.20	Professional	55	$272.73	$272.73	$279.20
United Facility/Professional Facility Modifier Low / Median / High Price $1,120.00 / $3,264.00 / $7,600.00	Facility		$1,120.00	$3,264.00	$7,600.00
United Facility/Professional Professional Modifier Low / Median / High Price $612.08 / $846.63 / $1,318.10	Professional		$612.08	$846.63	$1,318.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $609.83 / $693.19 / $968.68	Professional		$609.83	$693.19	$968.68