Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $935.00 / $3,792.00 / $13,004.00	Facility		$935.00	$3,792.00	$13,004.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $136.41 / $147.26 / $203.74	Facility	53	$136.41	$147.26	$203.74
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $511.58 / $552.21 / $764.03	Facility	54	$511.58	$552.21	$764.03
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $102.32 / $110.44 / $152.81	Facility	55	$102.32	$110.44	$152.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $584.94 / $717.61 / $1,050.54	Professional		$584.94	$717.61	$1,050.54
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $87.74 / $110.44 / $156.68	Professional	55	$87.74	$110.44	$156.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $338.53 / $636.69 / $1,222.70	Professional		$338.53	$636.69	$1,222.70
BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,986.00 / $6,673.28 / $13,304.06	Facility		$3,986.00	$6,673.28	$13,304.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $537.01 / $713.73 / $1,053.75	Professional		$537.01	$713.73	$1,053.75
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $1,267.26 / $6,015.52 / $10,339.18	Facility		$1,267.26	$6,015.52	$10,339.18
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $659.44 / $757.80 / $1,177.88	Professional		$659.44	$757.80	$1,177.88
Christus Facility/Professional Facility Modifier Low / Median / High Price $569.58 / $5,352.59 / $5,352.59	Facility		$569.58	$5,352.59	$5,352.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $4,628.32 / $4,628.32 / $4,779.59	Facility		$4,628.32	$4,628.32	$4,779.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $671.21 / $847.21 / $1,273.36	Professional		$671.21	$847.21	$1,273.36
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $55.00 / $21,325.00	Facility		$55.00	$55.00	$21,325.00
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $314.68 / $4,042.62 / $4,042.62	Facility	53	$314.68	$4,042.62	$4,042.62
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $1,101.39 / $14,149.17 / $14,149.17	Facility	54	$1,101.39	$14,149.17	$14,149.17
Lucent Health Facility/Professional Facility Modifier 55 Low / Median / High Price $236.01 / $3,031.96 / $3,031.96	Facility	55	$236.01	$3,031.96	$3,031.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,949.35 / $5,089.60 / $5,600.48	Professional		$4,949.35	$5,089.60	$5,600.48
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $636.69 / $758.36 / $1,270.97	Facility		$636.69	$758.36	$1,270.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $636.69 / $853.62 / $1,181.93	Professional		$636.69	$853.62	$1,181.93
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $580.58 / $697.61 / $1,236.10	Professional		$580.58	$697.61	$1,236.10
Providence Facility/Professional Facility Modifier Low / Median / High Price $636.69 / $764.03 / $1,299.82	Facility		$636.69	$764.03	$1,299.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $671.21 / $875.77 / $1,298.89	Professional		$671.21	$875.77	$1,298.89
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $249.84 / $249.84 / $255.76	Professional	55	$249.84	$249.84	$255.76
United Facility/Professional Facility Modifier Low / Median / High Price $2,093.00 / $6,556.00 / $13,237.00	Facility		$2,093.00	$6,556.00	$13,237.00
United Facility/Professional Professional Modifier Low / Median / High Price $534.58 / $712.77 / $1,086.25	Professional		$534.58	$712.77	$1,086.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $560.41 / $636.69 / $890.24	Professional		$560.41	$636.69	$890.24