Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $289.27 / $1,081.08 / $4,029.00	Facility		$289.27	$1,081.08	$4,029.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,376.23 / $2,376.23 / $2,376.23	Facility	50	$2,376.23	$2,376.23	$2,376.23
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $199.25 / $212.54 / $246.18	Facility	54	$199.25	$212.54	$246.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.77 / $284.41 / $404.45	Professional		$229.77	$284.41	$404.45
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $635.69 / $635.69 / $635.69	Professional	50	$635.69	$635.69	$635.69
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $144.08 / $206.63 / $262.58	Professional	54	$144.08	$206.63	$262.58
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $28.82 / $39.85 / $49.24	Professional	55	$28.82	$39.85	$49.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $190.04 / $201.33 / $417.53	Professional		$190.04	$201.33	$417.53
BCBS Facility/Professional Facility Modifier Low / Median / High Price $227.81 / $265.52 / $359.74	Facility		$227.81	$265.52	$359.74
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $122.07 / $185.00 / $234.59	Facility	50	$122.07	$185.00	$234.59
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.61 / $205.45 / $376.67	Professional		$38.61	$205.45	$376.67
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $383.67 / $383.67 / $458.01	Professional	50	$383.67	$383.67	$458.01
CareSource Facility/Professional Facility Modifier Low / Median / High Price $189.00 / $237.55 / $258.94	Facility		$189.00	$237.55	$258.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $221.13 / $223.77 / $290.89	Professional		$221.13	$223.77	$290.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $191.41 / $288.77 / $447.55	Professional		$191.41	$288.77	$447.55
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $340.52 / $1,081.08 / $4,933.00	Facility		$340.52	$1,081.08	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $2,376.23 / $2,376.23 / $2,376.23	Facility	50	$2,376.23	$2,376.23	$2,376.23
Health Alliance Plan Facility/Professional Facility Modifier 54 Low / Median / High Price $199.25 / $199.25 / $237.39	Facility	54	$199.25	$199.25	$237.39
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $234.68 / $317.66 / $425.60	Professional		$234.68	$317.66	$425.60
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $635.69 / $635.69 / $635.69	Professional	50	$635.69	$635.69	$635.69
Health Alliance Plan Facility/Professional Professional Modifier 54 Low / Median / High Price $199.25 / $237.39 / $353.12	Professional	54	$199.25	$237.39	$353.12
Health Alliance Plan Facility/Professional Professional Modifier 55 Low / Median / High Price $38.72 / $44.60 / $51.15	Professional	55	$38.72	$44.60	$51.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $149.65 / $207.27 / $284.96	Professional		$149.65	$207.27	$284.96
United Facility/Professional Facility Modifier Low / Median / High Price $645.00 / $2,800.00 / $4,594.00	Facility		$645.00	$2,800.00	$4,594.00
United Facility/Professional Professional Modifier Low / Median / High Price $274.95 / $333.36 / $437.99	Professional		$274.95	$333.36	$437.99