Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $232.76 / $450.91 / $2,056.00	Facility		$232.76	$450.91	$2,056.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $311.81 / $323.81 / $338.18	Facility	54	$311.81	$323.81	$338.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $240.12 / $415.75 / $667.56	Professional		$240.12	$415.75	$667.56
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $219.58 / $311.81 / $339.94	Professional	54	$219.58	$311.81	$339.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $15.00 / $446.91 / $494.93	Professional		$15.00	$446.91	$494.93
BCBS Facility/Professional Facility Modifier Low / Median / High Price $253.93 / $297.54 / $418.49	Facility		$253.93	$297.54	$418.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.00 / $342.02 / $676.82	Professional		$72.00	$342.02	$676.82
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $553.16 / $650.79 / $678.51	Professional	50	$553.16	$650.79	$678.51
CareSource Facility/Professional Facility Modifier Low / Median / High Price $308.66 / $393.18 / $467.18	Facility		$308.66	$393.18	$467.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $320.58 / $428.94 / $539.37	Professional		$320.58	$428.94	$539.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.80 / $353.56 / $697.82	Professional		$251.80	$353.56	$697.82
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $232.76 / $465.43 / $4,933.00	Facility		$232.76	$465.43	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 54 Low / Median / High Price $311.81 / $311.81 / $325.66	Facility	54	$311.81	$311.81	$325.66
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $292.88 / $431.74 / $620.47	Professional		$292.88	$431.74	$620.47
Health Alliance Plan Facility/Professional Professional Modifier 54 Low / Median / High Price $235.77 / $325.66 / $465.98	Professional	54	$235.77	$325.66	$465.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $33.81 / $225.28 / $401.02	Professional		$33.81	$225.28	$401.02
United Facility/Professional Facility Modifier Low / Median / High Price $300.00 / $1,418.00 / $2,029.00	Facility		$300.00	$1,418.00	$2,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $308.89 / $371.13 / $522.87	Professional		$308.89	$371.13	$522.87