Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $413.58 / $466.03 / $2,877.00	Facility		$413.58	$466.03	$2,877.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,389.98 / $1,389.98 / $1,389.98	Facility	50	$1,389.98	$1,389.98	$1,389.98
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $299.12 / $310.19 / $332.88	Facility	54	$299.12	$310.19	$332.88
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $59.82 / $62.04 / $66.58	Facility	55	$59.82	$62.04	$66.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.89 / $352.44 / $556.57	Professional		$257.89	$352.44	$556.57
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $436.08 / $436.08 / $562.74	Professional	50	$436.08	$436.08	$562.74
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $217.75 / $299.12 / $332.88	Professional	54	$217.75	$299.12	$332.88
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $43.55 / $59.82 / $66.58	Professional	55	$43.55	$59.82	$66.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $300.05 / $323.23 / $569.35	Professional		$300.05	$323.23	$569.35
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $854.02 / $854.02 / $854.02	Professional	50	$854.02	$854.02	$854.02
BCBS Facility/Professional Facility Modifier Low / Median / High Price $665.17 / $772.03 / $1,045.97	Facility		$665.17	$772.03	$1,045.97
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $354.93 / $522.99 / $682.06	Facility	50	$354.93	$522.99	$682.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.42 / $368.10 / $690.20	Professional		$87.42	$368.10	$690.20
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $738.18 / $738.18 / $790.11	Professional	50	$738.18	$738.18	$790.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $283.11 / $355.31 / $386.43	Facility		$283.11	$355.31	$386.43
CareSource Facility/Professional Professional Modifier Low / Median / High Price $300.05 / $302.27 / $392.95	Professional		$300.05	$302.27	$392.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $241.13 / $300.30 / $564.23	Professional		$241.13	$300.30	$564.23
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $326.87 / $642.05 / $2,877.00	Facility		$326.87	$642.05	$2,877.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $1,389.98 / $1,389.98 / $1,389.98	Facility	50	$1,389.98	$1,389.98	$1,389.98
Health Alliance Plan Facility/Professional Facility Modifier 54 Low / Median / High Price $299.12 / $299.12 / $320.99	Facility	54	$299.12	$299.12	$320.99
Health Alliance Plan Facility/Professional Facility Modifier 55 Low / Median / High Price $59.82 / $59.82 / $64.20	Facility	55	$59.82	$59.82	$64.20
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $271.83 / $398.81 / $559.23	Professional		$271.83	$398.81	$559.23
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $493.94 / $493.94 / $562.74	Professional	50	$493.94	$493.94	$562.74
Health Alliance Plan Facility/Professional Professional Modifier 54 Low / Median / High Price $236.67 / $310.19 / $332.88	Professional	54	$236.67	$310.19	$332.88
Health Alliance Plan Facility/Professional Professional Modifier 55 Low / Median / High Price $52.39 / $62.04 / $66.58	Professional	55	$52.39	$62.04	$66.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $33.77 / $202.38 / $334.11	Professional		$33.77	$202.38	$334.11
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 $321.69 / $378.98 / $495.16	Professional		$321.69	$378.98	$495.16