Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $497.20 / $4,062.01 / $8,559.36	Facility		$497.20	$4,062.01	$8,559.36
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,740.00 / $3,547.22 / $7,265.22	Facility	50	$2,740.00	$3,547.22	$7,265.22
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $98.10 / $98.10 / $248.60	Facility	52	$98.10	$98.10	$248.60
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $39.24 / $39.24 / $99.44	Facility	53	$39.24	$39.24	$99.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.72 / $228.40 / $588.60	Professional		$139.72	$228.40	$588.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $108.25 / $270.37 / $942.48	Professional	50	$108.25	$270.37	$942.48
BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,596.83 / $4,890.93 / $11,485.71	Facility		$3,596.83	$4,890.93	$11,485.71
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $2,273.31 / $2,859.81 / $3,878.06	Facility	50	$2,273.31	$2,859.81	$3,878.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.85 / $247.13 / $467.91	Professional		$40.85	$247.13	$467.91
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $370.70 / $370.70 / $426.31	Professional	50	$370.70	$370.70	$426.31
CareSource Facility/Professional Facility Modifier Low / Median / High Price $146.22 / $197.41 / $217.19	Facility		$146.22	$197.41	$217.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $353.31 / $420.61 / $443.85	Professional		$353.31	$420.61	$443.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.10 / $315.26 / $777.04	Professional		$158.10	$315.26	$777.04
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $497.19 / $4,039.50 / $8,747.56	Facility		$497.19	$4,039.50	$8,747.56
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $2,740.00 / $3,547.22 / $7,265.22	Facility	50	$2,740.00	$3,547.22	$7,265.22
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $98.10 / $98.10 / $248.60	Facility	52	$98.10	$98.10	$248.60
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $39.24 / $39.24 / $99.44	Facility	53	$39.24	$39.24	$99.44
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $156.11 / $440.07 / $629.00	Professional		$156.11	$440.07	$629.00
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $236.73 / $270.37 / $942.48	Professional	50	$236.73	$270.37	$942.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $299.60 / $375.09 / $536.29	Professional		$299.60	$375.09	$536.29
United Facility/Professional Facility Modifier Low / Median / High Price $2,524.00 / $5,819.00 / $8,339.00	Facility		$2,524.00	$5,819.00	$8,339.00
United Facility/Professional Professional Modifier Low / Median / High Price $483.17 / $607.57 / $798.24	Professional		$483.17	$607.57	$798.24