Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $616.60 / $2,454.71 / $5,888.44	Facility		$616.60	$2,454.71	$5,888.44
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $52.48 / $104.71 / $151.36	Facility	53	$52.48	$104.71	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $295.12 / $831.76	Professional		$162.18	$295.12	$831.76
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $64.57 / $120.23 / $199.53	Professional	53	$64.57	$120.23	$199.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $181.97 / $257.04	Professional		$165.96	$181.97	$257.04
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $77.62 / $85.11 / $87.10	Professional	53	$77.62	$85.11	$87.10
BCBS Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $1,258.93 / $2,570.40	Facility		$707.95	$1,258.93	$2,570.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $275.42 / $426.58	Professional		$147.91	$275.42	$426.58
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $223.87 / $1,174.90	Facility		$177.83	$223.87	$1,174.90
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $158.49 / $467.74	Professional		$48.98	$158.49	$467.74
Christus Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $870.96 / $870.96	Facility		$165.96	$870.96	$870.96
Christus Facility/Professional Facility Modifier 53 Low / Median / High Price $81.28 / $81.28 / $181.97	Facility	53	$81.28	$81.28	$181.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $645.65 / $1,412.54	Facility		$371.54	$645.65	$1,412.54
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	22	$446.68	$446.68	$446.68
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	52	$295.12	$295.12	$295.12
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	53	$74.13	$74.13	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Professional		$302.00	$302.00	$302.00
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $64.57 / $141.25 / $251.19	Professional	53	$64.57	$141.25	$251.19
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $2,754.23 / $28,840.32 / $28,840.32	Facility		$2,754.23	$28,840.32	$28,840.32
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $2,238.72 / $2,238.72 / $2,238.72	Facility	52	$2,238.72	$2,238.72	$2,238.72
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $549.54 / $549.54 / $549.54	Facility	53	$549.54	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,187.76 / $2,818.38 / $2,818.38	Professional		$2,187.76	$2,818.38	$2,818.38
Lucent Health Facility/Professional Professional Modifier 53 Low / Median / High Price $120.23 / $120.23 / $251.19	Professional	53	$120.23	$120.23	$251.19
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $371.54 / $1,288.25	Facility		$173.78	$371.54	$1,288.25
Moda Health Facility/Professional Facility Modifier 53 Low / Median / High Price $57.54 / $114.82 / $223.87	Facility	53	$57.54	$114.82	$223.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $288.40 / $660.69	Professional		$162.18	$288.40	$660.69
Moda Health Facility/Professional Professional Modifier 53 Low / Median / High Price $64.57 / $123.03 / $218.78	Professional	53	$64.57	$123.03	$218.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $288.40	Professional		$32.36	$33.11	$288.40
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $2,511.89 / $2,884.03	Facility		$2,137.96	$2,511.89	$2,884.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $478.63 / $933.25	Professional		$162.18	$478.63	$933.25
Providence Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $338.84 / $645.65	Facility		$169.82	$338.84	$645.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $501.19	Professional		$302.00	$302.00	$501.19
Providence Facility/Professional Professional Modifier 53 Low / Median / High Price $40.74 / $107.15 / $251.19	Professional	53	$40.74	$107.15	$251.19
United Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $1,659.59 / $4,168.69	Facility		$416.87	$1,659.59	$4,168.69
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $302.00 / $524.81	Professional		$173.78	$302.00	$524.81
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	53	$204.17	$204.17	$204.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $363.08 / $407.38	Professional		$151.36	$363.08	$407.38
Wellpoint Facility/Professional Professional Modifier 53 Low / Median / High Price $75.86 / $190.55 / $269.15	Professional	53	$75.86	$190.55	$269.15