Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $3,467.37 / $4,897.79	Facility		$1,995.26	$3,467.37	$4,897.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $2,511.89	Professional		$1,995.26	$1,995.26	$2,511.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $81.28 / $81.28	Professional		$81.28	$81.28	$81.28
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $4,073.80 / $7,943.28	Facility		$1,659.59	$4,073.80	$7,943.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,137.96 / $2,137.96	Professional		$2,137.96	$2,137.96	$2,137.96
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $2,187.76 / $3,235.94	Professional		$1,995.26	$2,187.76	$3,235.94
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,905.46 / $1,995.26 / $1,995.26	Facility		$1,905.46	$1,995.26	$1,995.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $1,995.26	Professional		$1,995.26	$1,995.26	$1,995.26
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $10,000.00 / $10,000.00 / $10,000.00	Facility		$10,000.00	$10,000.00	$10,000.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $2,884.03 / $4,897.79	Facility		$1,995.26	$2,884.03	$4,897.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $1,995.26 / $2,511.89	Professional		$1,905.46	$1,995.26	$2,511.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,995.26	Professional		$1,949.84	$1,949.84	$1,995.26
Providence Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $2,884.03 / $6,309.57	Facility		$1,995.26	$2,884.03	$6,309.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $1,995.26	Professional		$1,995.26	$1,995.26	$1,995.26
United Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $1,995.26	Facility		$1,995.26	$1,995.26	$1,995.26
United Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $1,995.26	Professional		$1,995.26	$1,995.26	$1,995.26