Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,897.79 / $11,481.54 / $25,703.96	Facility		$4,897.79	$11,481.54	$25,703.96
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $34,673.69 / $34,673.69 / $34,673.69	Facility	22	$34,673.69	$34,673.69	$34,673.69
Aetna Facility/Professional Facility Modifier AS Low / Median / High Price $20,892.96 / $20,892.96 / $20,892.96	Facility	AS	$20,892.96	$20,892.96	$20,892.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,819.70 / $9,120.11	Professional		$1,174.90	$1,819.70	$9,120.11
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $158.49 / $323.59 / $912.01	Professional	AS	$158.49	$323.59	$912.01
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $1,071.52 / $1,698.24	Professional		$154.88	$1,071.52	$1,698.24
BCBS Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $426.58 / $1,023.29	Facility		$426.58	$426.58	$1,023.29
BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $2,290.87 / $3,162.28	Professional		$1,548.82	$2,290.87	$3,162.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,479.11 / $1,862.09 / $5,754.40	Facility		$1,479.11	$1,862.09	$5,754.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,659.59 / $2,951.21	Professional		$1,230.27	$1,659.59	$2,951.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,621.81 / $3,630.78	Professional		$1,000.00	$1,621.81	$3,630.78
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $4,168.69 / $9,772.37 / $24,547.09	Facility		$4,168.69	$9,772.37	$24,547.09
Health Alliance Plan Facility/Professional Facility Modifier 22 Low / Median / High Price $34,673.69 / $34,673.69 / $34,673.69	Facility	22	$34,673.69	$34,673.69	$34,673.69
Health Alliance Plan Facility/Professional Facility Modifier AS Low / Median / High Price $20,892.96 / $20,892.96 / $20,892.96	Facility	AS	$20,892.96	$20,892.96	$20,892.96
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,737.80 / $4,570.88	Professional		$1,202.26	$1,737.80	$4,570.88
Health Alliance Plan Facility/Professional Professional Modifier AS Low / Median / High Price $128.82 / $275.42 / $870.96	Professional	AS	$128.82	$275.42	$870.96
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,513.56 / $2,344.23	Professional		$933.25	$1,513.56	$2,344.23
United Facility/Professional Facility Modifier Low / Median / High Price $7,244.36 / $11,220.18 / $22,387.21	Facility		$7,244.36	$11,220.18	$22,387.21
United Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,698.24 / $2,238.72	Professional		$1,288.25	$1,698.24	$2,238.72