Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $995.38 / $3,065.61 / $6,791.31	Facility		$995.38	$3,065.61	$6,791.31
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $719.88 / $719.88 / $746.54	Facility	54	$719.88	$719.88	$746.54
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $143.97 / $143.97 / $149.31	Facility	55	$143.97	$143.97	$149.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $749.66 / $921.15 / $1,266.98	Professional		$749.66	$921.15	$1,266.98
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $521.48 / $719.88 / $746.54	Professional	54	$521.48	$719.88	$746.54
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $104.30 / $143.97 / $149.31	Professional	55	$104.30	$143.97	$149.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $364.44 / $728.87 / $1,263.57	Professional		$364.44	$728.87	$1,263.57
BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,988.56 / $6,979.88 / $9,456.62	Facility		$5,988.56	$6,979.88	$9,456.62
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $3,424.83 / $4,378.57 / $6,157.31	Facility	50	$3,424.83	$4,378.57	$6,157.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $187.01 / $1,045.04 / $1,650.06	Professional		$187.01	$1,045.04	$1,650.06
CareSource Facility/Professional Facility Modifier Low / Median / High Price $683.57 / $858.93 / $935.69	Facility		$683.57	$858.93	$935.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $673.49 / $683.57 / $888.64	Professional		$673.49	$683.57	$888.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $610.55 / $879.96 / $1,341.55	Professional		$610.55	$879.96	$1,341.55
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $995.38 / $4,933.00 / $8,686.02	Facility		$995.38	$4,933.00	$8,686.02
Health Alliance Plan Facility/Professional Facility Modifier 54 Low / Median / High Price $719.88 / $719.88 / $719.88	Facility	54	$719.88	$719.88	$719.88
Health Alliance Plan Facility/Professional Facility Modifier 55 Low / Median / High Price $143.97 / $143.97 / $143.97	Facility	55	$143.97	$143.97	$143.97
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $780.68 / $1,045.15 / $1,363.81	Professional		$780.68	$1,045.15	$1,363.81
Health Alliance Plan Facility/Professional Professional Modifier 54 Low / Median / High Price $663.84 / $719.88 / $905.19	Professional	54	$663.84	$719.88	$905.19
Health Alliance Plan Facility/Professional Professional Modifier 55 Low / Median / High Price $132.77 / $143.97 / $181.04	Professional	55	$132.77	$143.97	$181.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $68.38 / $524.55 / $818.36	Professional		$68.38	$524.55	$818.36
United Facility/Professional Facility Modifier Low / Median / High Price $1,450.00 / $5,708.00 / $8,884.00	Facility		$1,450.00	$5,708.00	$8,884.00
United Facility/Professional Professional Modifier Low / Median / High Price $810.86 / $1,032.89 / $1,331.72	Professional		$810.86	$1,032.89	$1,331.72