Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $762.74 / $4,698.87 / $6,933.09	Facility		$762.74	$4,698.87	$6,933.09
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $140.10 / $140.10 / $613.12	Facility	53	$140.10	$140.10	$613.12
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $525.36 / $525.36 / $3,596.49	Facility	54	$525.36	$525.36	$3,596.49
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $105.07 / $105.07 / $108.96	Facility	55	$105.07	$105.07	$108.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $507.67 / $700.48 / $1,548.05	Professional		$507.67	$700.48	$1,548.05
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $4,329.68 / $4,329.68 / $4,329.68	Professional	50	$4,329.68	$4,329.68	$4,329.68
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $253.84 / $350.24 / $363.21	Professional	52	$253.84	$350.24	$363.21
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $380.75 / $525.36 / $997.50	Professional	54	$380.75	$525.36	$997.50
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $60.70 / $103.07 / $130.38	Professional	55	$60.70	$103.07	$130.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $491.82 / $531.51 / $922.17	Professional		$491.82	$531.51	$922.17
BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,210.93 / $4,908.00 / $6,649.56	Facility		$4,210.93	$4,908.00	$6,649.56
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $2,408.21 / $3,848.57 / $4,508.57	Facility	50	$2,408.21	$3,848.57	$4,508.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.88 / $803.24 / $1,265.09	Professional		$151.88	$803.24	$1,265.09
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $1,288.61 / $1,288.61 / $1,288.61	Professional	50	$1,288.61	$1,288.61	$1,288.61
CareSource Facility/Professional Facility Modifier Low / Median / High Price $498.64 / $626.41 / $682.44	Facility		$498.64	$626.41	$682.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $491.82 / $498.64 / $648.23	Professional		$491.82	$498.64	$648.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $490.78 / $662.33 / $979.63	Professional		$490.78	$662.33	$979.63
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $762.74 / $4,929.47 / $9,250.61	Facility		$762.74	$4,929.47	$9,250.61
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $140.10 / $140.10 / $613.12	Facility	53	$140.10	$140.10	$613.12
Health Alliance Plan Facility/Professional Facility Modifier 54 Low / Median / High Price $525.36 / $525.36 / $3,596.49	Facility	54	$525.36	$525.36	$3,596.49
Health Alliance Plan Facility/Professional Facility Modifier 55 Low / Median / High Price $105.07 / $105.07 / $105.07	Facility	55	$105.07	$105.07	$105.07
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $519.94 / $726.41 / $1,032.53	Professional		$519.94	$726.41	$1,032.53
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $323.39 / $350.24 / $434.61	Professional	52	$323.39	$350.24	$434.61
Health Alliance Plan Facility/Professional Professional Modifier 54 Low / Median / High Price $454.65 / $525.36 / $1,490.94	Professional	54	$454.65	$525.36	$1,490.94
Health Alliance Plan Facility/Professional Professional Modifier 55 Low / Median / High Price $38.33 / $105.07 / $154.88	Professional	55	$38.33	$105.07	$154.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $67.99 / $360.59 / $591.60	Professional		$67.99	$360.59	$591.60
United Facility/Professional Facility Modifier Low / Median / High Price $2,248.00 / $4,985.00 / $8,339.00	Facility		$2,248.00	$4,985.00	$8,339.00
United Facility/Professional Professional Modifier Low / Median / High Price $600.84 / $745.68 / $1,024.19	Professional		$600.84	$745.68	$1,024.19