Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $94.11 / $270.60 / $4,933.00	Facility		$94.11	$270.60	$4,933.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.37 / $123.36 / $225.63	Professional		$79.37	$123.36	$225.63
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $34.29 / $49.40 / $75.81	Professional	52	$34.29	$49.40	$75.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $110.64 / $130.16 / $156.99	Professional		$110.64	$130.16	$156.99
BCBS Facility/Professional Facility Modifier Low / Median / High Price $402.12 / $469.06 / $659.93	Facility		$402.12	$469.06	$659.93
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.45 / $54.10 / $107.10	Professional		$16.45	$54.10	$107.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $78.33 / $86.16 / $116.34	Facility		$78.33	$86.16	$116.34
CareSource Facility/Professional Professional Modifier Low / Median / High Price $126.03 / $133.34 / $198.88	Professional		$126.03	$133.34	$198.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.34 / $114.48 / $362.56	Professional		$69.34	$114.48	$362.56
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $94.11 / $270.60 / $4,933.00	Facility		$94.11	$270.60	$4,933.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $94.93 / $129.34 / $217.80	Professional		$94.93	$129.34	$217.80
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $37.34 / $56.79 / $75.81	Professional	52	$37.34	$56.79	$75.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $89.21 / $119.07 / $168.26	Professional		$89.21	$119.07	$168.26
United Facility/Professional Facility Modifier Low / Median / High Price $267.42 / $1,205.00 / $2,029.00	Facility		$267.42	$1,205.00	$2,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $118.32 / $142.41 / $194.11	Professional		$118.32	$142.41	$194.11