Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $1,698.24 / $2,511.89	Facility		$181.97	$1,698.24	$2,511.89
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,380.38 / $2,041.74 / $4,265.80	Facility	50	$1,380.38	$2,041.74	$4,265.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $251.19 / $1,000.00	Professional		$104.71	$251.19	$1,000.00
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $141.25 / $478.63 / $1,548.82	Professional	22	$141.25	$478.63	$1,548.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $169.82 / $407.38 / $1,348.96	Professional	50	$169.82	$407.38	$1,348.96
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $138.04 / $138.04 / $186.21	Professional	53	$138.04	$138.04	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $154.88 / $346.74	Professional		$102.33	$154.88	$346.74
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $147.91 / $213.80 / $562.34	Professional	50	$147.91	$213.80	$562.34
BCBS Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $251.19 / $251.19	Facility		$165.96	$251.19	$251.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $251.19 / $389.05	Professional		$165.96	$251.19	$389.05
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $263.03 / $263.03 / $588.84	Professional	50	$263.03	$263.03	$588.84
CareSource Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $162.18 / $229.09	Facility		$125.89	$162.18	$229.09
CareSource Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $302.00 / $512.86	Professional		$218.78	$302.00	$512.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $190.55 / $416.87	Professional		$97.72	$190.55	$416.87
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $1,584.89 / $2,511.89	Facility		$251.19	$1,584.89	$2,511.89
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $794.33 / $1,949.84 / $4,073.80	Facility	50	$794.33	$1,949.84	$4,073.80
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $263.03 / $602.56	Professional		$112.20	$263.03	$602.56
Health Alliance Plan Facility/Professional Professional Modifier 22 Low / Median / High Price $141.25 / $190.55 / $1,548.82	Professional	22	$141.25	$190.55	$1,548.82
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $165.96 / $407.38 / $1,348.96	Professional	50	$165.96	$407.38	$1,348.96
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $138.04 / $138.04 / $186.21	Professional	53	$138.04	$138.04	$186.21
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $181.97 / $371.54	Professional		$91.20	$181.97	$371.54
United Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $1,778.28 / $4,073.80	Facility		$691.83	$1,778.28	$4,073.80
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $204.17 / $346.74	Professional		$114.82	$204.17	$346.74