Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4,786.30 / $9,549.93 / $25,118.86	Facility		$4,786.30	$9,549.93	$25,118.86
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $25,118.86 / $25,118.86 / $25,118.86	Facility	22	$25,118.86	$25,118.86	$25,118.86
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $5,495.41 / $11,220.18 / $28,840.32	Facility	50	$5,495.41	$11,220.18	$28,840.32
Aetna Facility/Professional Facility Modifier AS Low / Median / High Price $602.56 / $9,332.54 / $9,332.54	Facility	AS	$602.56	$9,332.54	$9,332.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,862.09 / $21,877.62	Professional		$1,174.90	$1,862.09	$21,877.62
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $169.82 / $331.13 / $977.24	Professional	AS	$169.82	$331.13	$977.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $1,122.02 / $1,737.80	Professional		$154.88	$1,122.02	$1,737.80
Ambetter Facility/Professional Professional Modifier AS Low / Median / High Price $138.04 / $302.00 / $354.81	Professional	AS	$138.04	$302.00	$354.81
BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $3,162.28 / $3,162.28	Facility		$2,454.71	$3,162.28	$3,162.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $2,290.87 / $3,162.28	Professional		$1,023.29	$2,290.87	$3,162.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,445.44 / $1,862.09 / $6,309.57	Facility		$1,445.44	$1,862.09	$6,309.57
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 $1,071.52 / $1,621.81 / $3,630.78	Professional		$1,071.52	$1,621.81	$3,630.78
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $4,365.16 / $9,332.54 / $22,908.68	Facility		$4,365.16	$9,332.54	$22,908.68
Health Alliance Plan Facility/Professional Facility Modifier 22 Low / Median / High Price $25,118.86 / $25,118.86 / $25,118.86	Facility	22	$25,118.86	$25,118.86	$25,118.86
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $5,495.41 / $8,317.64 / $28,840.32	Facility	50	$5,495.41	$8,317.64	$28,840.32
Health Alliance Plan Facility/Professional Facility Modifier AS Low / Median / High Price $602.56 / $602.56 / $9,332.54	Facility	AS	$602.56	$602.56	$9,332.54
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,778.28 / $4,786.30	Professional		$1,230.27	$1,778.28	$4,786.30
Health Alliance Plan Facility/Professional Professional Modifier AS Low / Median / High Price $169.82 / $302.00 / $954.99	Professional	AS	$169.82	$302.00	$954.99
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,584.89 / $2,344.23	Professional		$977.24	$1,584.89	$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 / $1,737.80 / $2,238.72	Professional		$1,288.25	$1,737.80	$2,238.72