Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $1,174.90 / $4,897.79	Facility		$467.74	$1,174.90	$4,897.79
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,380.38 / $1,380.38 / $1,380.38	Facility	50	$1,380.38	$1,380.38	$1,380.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $371.54 / $831.76	Professional		$288.40	$371.54	$831.76
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $467.74 / $812.83 / $2,344.23	Professional	50	$467.74	$812.83	$2,344.23
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $234.42 / $288.40 / $912.01	Professional	54	$234.42	$288.40	$912.01
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $53.70 / $61.66 / $389.05	Professional	55	$53.70	$61.66	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $288.40 / $380.19	Professional		$223.87	$288.40	$380.19
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $489.78 / $489.78 / $588.84	Professional	50	$489.78	$489.78	$588.84
BCBS Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $457.09 / $457.09	Facility		$77.62	$457.09	$457.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $524.81 / $691.83	Professional		$288.40	$524.81	$691.83
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $741.31 / $794.33 / $794.33	Professional	50	$741.31	$794.33	$794.33
CareSource Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $338.84 / $389.05	Facility		$281.84	$338.84	$389.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $323.59	Professional		$302.00	$302.00	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $323.59 / $707.95	Professional		$239.88	$323.59	$707.95
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $954.99 / $4,897.79	Facility		$426.58	$954.99	$4,897.79
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $1,380.38 / $1,380.38 / $1,380.38	Facility	50	$1,380.38	$1,380.38	$1,380.38
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $398.11 / $630.96	Professional		$288.40	$398.11	$630.96
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $457.09 / $724.44 / $1,819.70	Professional	50	$457.09	$724.44	$1,819.70
Health Alliance Plan Facility/Professional Professional Modifier 54 Low / Median / High Price $234.42 / $245.47 / $912.01	Professional	54	$234.42	$245.47	$912.01
Health Alliance Plan Facility/Professional Professional Modifier 55 Low / Median / High Price $53.70 / $56.23 / $389.05	Professional	55	$53.70	$56.23	$389.05
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $275.42 / $389.05	Professional		$239.88	$275.42	$389.05
United Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $1,584.89 / $4,073.80	Facility		$426.58	$1,584.89	$4,073.80
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $363.08 / $467.74	Professional		$302.00	$363.08	$467.74