Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,967.70 / $6,920.92 / $15,416.03	Facility		$1,967.70	$6,920.92	$15,416.03
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $11,011.00 / $11,011.00 / $11,011.00	Facility	22	$11,011.00	$11,011.00	$11,011.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $315.44 / $339.61 / $504.71	Facility	52	$315.44	$339.61	$504.71
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $126.17 / $135.84 / $201.88	Facility	53	$126.17	$135.84	$201.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $629.48 / $732.74 / $2,614.27	Professional		$629.48	$732.74	$2,614.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $585.80 / $649.80 / $883.23	Professional		$585.80	$649.80	$883.23
BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,100.47 / $7,250.57 / $14,597.80	Facility		$4,100.47	$7,250.57	$14,597.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $528.98 / $653.27 / $1,024.35	Professional		$528.98	$653.27	$1,024.35
Baylor Scott & White Facility/Professional Facility Modifier Low / Median / High Price $1,267.26 / $4,576.51 / $12,618.47	Facility		$1,267.26	$4,576.51	$12,618.47
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $354.07 / $693.97 / $1,074.83	Professional		$354.07	$693.97	$1,074.83
Christus Facility/Professional Facility Modifier Low / Median / High Price $615.76 / $5,480.04 / $5,480.04	Facility		$615.76	$5,480.04	$5,480.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,094.91 / $4,105.82 / $9,352.00	Facility		$3,094.91	$4,105.82	$9,352.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $74.27 / $74.27	Facility	AS	$74.27	$74.27	$74.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $661.77 / $889.61 / $1,371.21	Professional		$661.77	$889.61	$1,371.21
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $4,956.00 / $10,160.00 / $16,223.75	Facility		$4,956.00	$10,160.00	$16,223.75
Lucent Health Facility/Professional Facility Modifier 52 Low / Median / High Price $1,169.61 / $12,302.24 / $12,302.24	Facility	52	$1,169.61	$12,302.24	$12,302.24
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $292.39 / $3,075.56 / $3,075.56	Facility	53	$292.39	$3,075.56	$3,075.56
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $146.19 / $1,537.78 / $1,537.78	Facility	AS	$146.19	$1,537.78	$1,537.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,971.47 / $4,971.47 / $5,729.25	Professional		$4,971.47	$4,971.47	$5,729.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $641.32 / $840.31 / $1,577.20	Facility		$641.32	$840.31	$1,577.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $724.86 / $992.77 / $1,269.64	Professional		$724.86	$992.77	$1,269.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $630.88 / $814.94 / $1,407.00	Professional		$630.88	$814.94	$1,407.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $642.71 / $847.54 / $1,647.36	Facility		$642.71	$847.54	$1,647.36
Providence Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $253.88 / $253.88 / $253.88	Facility	80	$253.88	$253.88	$253.88
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $215.80 / $215.80	Facility	AS	$74.27	$215.80	$215.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $676.32 / $951.19 / $1,668.30	Professional		$676.32	$951.19	$1,668.30
United Facility/Professional Facility Modifier Low / Median / High Price $2,605.00 / $7,096.00 / $16,000.00	Facility		$2,605.00	$7,096.00	$16,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $554.04 / $743.72 / $1,177.34	Professional		$554.04	$743.72	$1,177.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $553.79 / $643.84 / $869.06	Professional		$553.79	$643.84	$869.06