Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $157.19 / $1,013.69 / $2,345.38	Facility		$157.19	$1,013.69	$2,345.38
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $43.59 / $43.59 / $78.59	Facility	52	$43.59	$43.59	$78.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.25 / $115.02 / $189.42	Professional		$65.25	$115.02	$189.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.69 / $104.25 / $131.85	Professional		$84.69	$104.25	$131.85
BCBS Facility/Professional Facility Modifier Low / Median / High Price $754.03 / $1,109.74 / $2,669.54	Facility		$754.03	$1,109.74	$2,669.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $15.52 / $85.22 / $142.44	Professional		$15.52	$85.22	$142.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $68.78 / $92.85 / $102.16	Facility		$68.78	$92.85	$102.16
CareSource Facility/Professional Professional Modifier Low / Median / High Price $126.44 / $150.53 / $160.08	Professional		$126.44	$150.53	$160.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.76 / $136.38 / $242.15	Professional		$78.76	$136.38	$242.15
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $157.19 / $1,253.13 / $2,345.38	Facility		$157.19	$1,253.13	$2,345.38
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $43.59 / $43.59 / $78.59	Facility	52	$43.59	$43.59	$78.59
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $87.18 / $130.35 / $204.35	Professional		$87.18	$130.35	$204.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.79 / $102.47 / $146.52	Professional		$81.79	$102.47	$146.52
United Facility/Professional Facility Modifier Low / Median / High Price $773.00 / $3,005.00 / $4,504.00	Facility		$773.00	$3,005.00	$4,504.00
United Facility/Professional Professional Modifier Low / Median / High Price $139.07 / $161.55 / $217.88	Professional		$139.07	$161.55	$217.88