Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,483.52 / $9,556.89 / $19,019.45	Facility		$4,483.52	$9,556.89	$19,019.45
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $24,884.12 / $24,884.12 / $24,884.12	Facility	22	$24,884.12	$24,884.12	$24,884.12
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $5,483.00 / $11,275.41 / $29,023.35	Facility	50	$5,483.00	$11,275.41	$29,023.35
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,233.38 / $1,233.38 / $1,280.81	Facility	54	$1,233.38	$1,233.38	$1,280.81
Aetna Facility/Professional Facility Modifier AS Low / Median / High Price $598.16 / $9,362.60 / $9,362.60	Facility	AS	$598.16	$9,362.60	$9,362.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,274.57 / $1,662.73 / $5,751.30	Professional		$1,274.57	$1,662.73	$5,751.30
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $94.52 / $227.83 / $459.90	Professional	AS	$94.52	$227.83	$459.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,223.66 / $1,429.22 / $2,224.55	Professional		$1,223.66	$1,429.22	$2,224.55
BCBS Facility/Professional Facility Modifier Low / Median / High Price $22,674.73 / $26,613.46 / $36,057.01	Facility		$22,674.73	$26,613.46	$36,057.01
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $13,058.48 / $16,694.97 / $24,447.61	Facility	50	$13,058.48	$16,694.97	$24,447.61
BCBS Facility/Professional Professional Modifier Low / Median / High Price $324.67 / $1,462.31 / $3,445.75	Professional		$324.67	$1,462.31	$3,445.75
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,217.83 / $1,583.18 / $2,252.56	Facility		$1,217.83	$1,583.18	$2,252.56
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,185.56 / $1,606.62 / $2,005.67	Professional		$1,185.56	$1,606.62	$2,005.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $985.33 / $1,680.04 / $2,715.03	Professional		$985.33	$1,680.04	$2,715.03
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $3,783.29 / $9,556.89 / $19,019.45	Facility		$3,783.29	$9,556.89	$19,019.45
Health Alliance Plan Facility/Professional Facility Modifier 22 Low / Median / High Price $24,884.12 / $24,884.12 / $24,884.12	Facility	22	$24,884.12	$24,884.12	$24,884.12
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $5,483.00 / $8,267.32 / $29,023.35	Facility	50	$5,483.00	$8,267.32	$29,023.35
Health Alliance Plan Facility/Professional Facility Modifier 54 Low / Median / High Price $1,233.38 / $1,233.38 / $1,233.38	Facility	54	$1,233.38	$1,233.38	$1,233.38
Health Alliance Plan Facility/Professional Facility Modifier AS Low / Median / High Price $598.16 / $9,362.60 / $9,362.60	Facility	AS	$598.16	$9,362.60	$9,362.60
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $1,298.77 / $1,707.75 / $3,980.51	Professional		$1,298.77	$1,707.75	$3,980.51
Health Alliance Plan Facility/Professional Professional Modifier AS Low / Median / High Price $168.45 / $266.95 / $459.90	Professional	AS	$168.45	$266.95	$459.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $137.33 / $886.42 / $1,477.41	Professional		$137.33	$886.42	$1,477.41
United Facility/Professional Facility Modifier Low / Median / High Price $5,356.00 / $11,464.00 / $17,095.00	Facility		$5,356.00	$11,464.00	$17,095.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,384.01 / $1,795.48 / $2,437.98	Professional		$1,384.01	$1,795.48	$2,437.98