Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,708.73 / $7,365.00 / $20,013.45	Facility		$1,708.73	$7,365.00	$20,013.45
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $3,821.00 / $4,195.27 / $14,066.49	Facility	22	$3,821.00	$4,195.27	$14,066.49
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $8,459.87 / $16,373.06 / $29,546.89	Facility	50	$8,459.87	$16,373.06	$29,546.89
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $797.60 / $883.10 / $1,468.13	Facility	54	$797.60	$883.10	$1,468.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,141.10 / $1,328.51 / $2,437.17	Professional		$1,141.10	$1,328.51	$2,437.17
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $158.15 / $277.41 / $836.81	Professional	AS	$158.15	$277.41	$836.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $219.63 / $1,340.37 / $1,687.79	Professional		$219.63	$1,340.37	$1,687.79
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,820.86 / $15,827.94 / $36,178.16	Facility		$1,820.86	$15,827.94	$36,178.16
BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,027.70 / $1,276.22 / $1,990.14	Professional		$1,027.70	$1,276.22	$1,990.14
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $515.36 / $4,000.00 / $17,480.72	Facility		$515.36	$4,000.00	$17,480.72
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $730.81 / $1,529.30 / $2,392.00	Professional		$730.81	$1,529.30	$2,392.00
Christus Facility/Professional Facility Modifier Low / Median / High Price $1,134.41 / $11,600.24 / $11,600.24	Facility		$1,134.41	$11,600.24	$11,600.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,455.37 / $1,455.37 / $1,455.37	Facility		$1,455.37	$1,455.37	$1,455.37
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,008.15 / $1,008.15 / $1,008.15	Facility	54	$1,008.15	$1,008.15	$1,008.15
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $900.13 / $900.13 / $900.13	Facility	62	$900.13	$900.13	$900.13
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $144.02 / $144.02 / $144.02	Facility	AS	$144.02	$144.02	$144.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,305.67 / $1,811.14 / $2,919.50	Professional		$1,305.67	$1,811.14	$2,919.50
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $25,000.00 / $53,594.95	Facility		$55.00	$25,000.00	$53,594.95
Lucent Health Facility/Professional Facility Modifier 54 Low / Median / High Price $2,023.31 / $35,560.28 / $35,560.28	Facility	54	$2,023.31	$35,560.28	$35,560.28
Lucent Health Facility/Professional Facility Modifier 62 Low / Median / High Price $1,806.53 / $31,750.25 / $31,750.25	Facility	62	$1,806.53	$31,750.25	$31,750.25
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $289.04 / $5,080.04 / $5,080.04	Facility	AS	$289.04	$5,080.04	$5,080.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $13,550.61 / $13,550.61 / $13,550.61	Professional		$13,550.61	$13,550.61	$13,550.61
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $1,253.82 / $1,714.62 / $2,986.59	Facility		$1,253.82	$1,714.62	$2,986.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,448.14 / $1,926.65 / $2,507.28	Professional		$1,448.14	$1,926.65	$2,507.28
Moda Health Facility/Professional Professional Modifier AS Low / Median / High Price $86.00 / $160.00 / $248.65	Professional	AS	$86.00	$160.00	$248.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,252.58 / $2,063.64 / $4,560.25	Professional		$1,252.58	$2,063.64	$4,560.25
Providence Facility/Professional Facility Modifier Low / Median / High Price $1,252.58 / $1,714.62 / $2,980.90	Facility		$1,252.58	$1,714.62	$2,980.90
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $1,008.15 / $1,008.15 / $2,442.41	Facility	54	$1,008.15	$1,008.15	$2,442.41
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $900.13 / $900.13 / $1,908.13	Facility	62	$900.13	$900.13	$1,908.13
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $488.48 / $488.48 / $488.48	Facility	80	$488.48	$488.48	$488.48
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $144.02 / $144.02 / $415.21	Facility	AS	$144.02	$144.02	$415.21
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,322.40 / $1,884.10 / $2,884.34	Professional		$1,322.40	$1,884.10	$2,884.34
Providence Facility/Professional Professional Modifier AS Low / Median / High Price $325.76 / $353.59 / $414.45	Professional	AS	$325.76	$353.59	$414.45
United Facility/Professional Facility Modifier Low / Median / High Price $4,738.00 / $9,486.00 / $27,418.00	Facility		$4,738.00	$9,486.00	$27,418.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,084.19 / $1,478.79 / $2,355.53	Professional		$1,084.19	$1,478.79	$2,355.53
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,074.73 / $1,223.44 / $1,692.66	Professional		$1,074.73	$1,223.44	$1,692.66