Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $259.95 / $539.84 / $4,933.00	Facility		$259.95	$539.84	$4,933.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $194.96 / $202.46 / $214.97	Facility	54	$194.96	$202.46	$214.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.61 / $254.09 / $372.70	Professional		$175.61	$254.09	$372.70
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $138.31 / $194.96 / $214.97	Professional	54	$138.31	$194.96	$214.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.47 / $193.67 / $276.67	Professional		$112.47	$193.67	$276.67
Ambetter Facility/Professional Professional Modifier 54 Low / Median / High Price $193.67 / $193.67 / $193.67	Professional	54	$193.67	$193.67	$193.67
BCBS Facility/Professional Facility Modifier Low / Median / High Price $205.40 / $241.08 / $326.63	Facility		$205.40	$241.08	$326.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.93 / $224.43 / $416.64	Professional		$42.93	$224.43	$416.64
CareSource Facility/Professional Facility Modifier Low / Median / High Price $192.93 / $245.54 / $291.75	Facility		$192.93	$245.54	$291.75
CareSource Facility/Professional Professional Modifier Low / Median / High Price $204.26 / $271.56 / $341.93	Professional		$204.26	$271.56	$341.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.38 / $239.22 / $444.82	Professional		$162.38	$239.22	$444.82
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $211.55 / $539.84 / $4,933.00	Facility		$211.55	$539.84	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 54 Low / Median / High Price $194.96 / $194.96 / $207.00	Facility	54	$194.96	$194.96	$207.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $196.40 / $269.94 / $381.91	Professional		$196.40	$269.94	$381.91
Health Alliance Plan Facility/Professional Professional Modifier 54 Low / Median / High Price $153.41 / $207.00 / $268.48	Professional	54	$153.41	$207.00	$268.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.13 / $172.11 / $278.26	Professional		$32.13	$172.11	$278.26
United Facility/Professional Facility Modifier Low / Median / High Price $174.86 / $961.00 / $1,844.00	Facility		$174.86	$961.00	$1,844.00
United Facility/Professional Professional Modifier Low / Median / High Price $213.10 / $253.61 / $351.25	Professional		$213.10	$253.61	$351.25