Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.75 / $1,308.49 / $4,933.00	Facility		$151.75	$1,308.49	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,649.16 / $1,649.16 / $1,649.16	Facility	50	$1,649.16	$1,649.16	$1,649.16
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $69.59 / $72.27 / $203.13	Facility	52	$69.59	$72.27	$203.13
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $27.84 / $28.91 / $81.25	Facility	53	$27.84	$28.91	$81.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.65 / $255.75 / $614.79	Professional		$96.65	$255.75	$614.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $90.00 / $120.00 / $279.12	Professional		$90.00	$120.00	$279.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $939.34 / $1,096.49 / $1,493.72	Facility		$939.34	$1,096.49	$1,493.72
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $633.58 / $768.18 / $974.04	Facility	50	$633.58	$768.18	$974.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.17 / $167.84 / $299.70	Professional		$27.17	$167.84	$299.70
CareSource Facility/Professional Facility Modifier Low / Median / High Price $101.95 / $137.63 / $151.41	Facility		$101.95	$137.63	$151.41
CareSource Facility/Professional Professional Modifier Low / Median / High Price $290.68 / $346.05 / $362.86	Professional		$290.68	$346.05	$362.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.64 / $227.74 / $887.66	Professional		$109.64	$227.74	$887.66
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $328.93 / $1,637.05 / $4,933.00	Facility		$328.93	$1,637.05	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $1,649.16 / $1,649.16 / $1,649.16	Facility	50	$1,649.16	$1,649.16	$1,649.16
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $69.59 / $69.59 / $195.61	Facility	52	$69.59	$69.59	$195.61
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $27.84 / $27.84 / $78.23	Facility	53	$27.84	$27.84	$78.23
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $139.18 / $346.50 / $633.91	Professional		$139.18	$346.50	$633.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $244.92 / $306.53 / $436.75	Professional		$244.92	$306.53	$436.75
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 $332.05 / $497.98 / $1,003.30	Professional		$332.05	$497.98	$1,003.30