Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $116.29 / $1,206.23 / $4,933.00	Facility		$116.29	$1,206.23	$4,933.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $56.07 / $58.15 / $143.08	Facility	52	$56.07	$58.15	$143.08
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $22.43 / $23.26 / $57.23	Facility	53	$22.43	$23.26	$57.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.56 / $177.58 / $302.02	Professional		$99.56	$177.58	$302.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.80 / $85.59 / $160.56	Professional		$42.80	$85.59	$160.56
BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,350.79 / $5,947.14 / $13,714.58	Facility		$4,350.79	$5,947.14	$13,714.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.13 / $117.80 / $206.89	Professional		$22.13	$117.80	$206.89
CareSource Facility/Professional Facility Modifier Low / Median / High Price $79.28 / $107.03 / $117.75	Facility		$79.28	$107.03	$117.75
CareSource Facility/Professional Professional Modifier Low / Median / High Price $196.15 / $196.15 / $233.51	Professional		$196.15	$196.15	$233.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.44 / $173.09 / $392.48	Professional		$90.44	$173.09	$392.48
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $116.29 / $1,595.40 / $4,933.00	Facility		$116.29	$1,595.40	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $56.07 / $56.07 / $137.97	Facility	52	$56.07	$56.07	$137.97
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $22.43 / $22.43 / $55.19	Facility	53	$22.43	$22.43	$55.19
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $104.35 / $236.88 / $354.81	Professional		$104.35	$236.88	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $166.06 / $205.47 / $294.46	Professional		$166.06	$205.47	$294.46
United Facility/Professional Facility Modifier Low / Median / High Price $773.00 / $3,005.00 / $4,594.00	Facility		$773.00	$3,005.00	$4,594.00
United Facility/Professional Professional Modifier Low / Median / High Price $241.36 / $311.81 / $395.40	Professional		$241.36	$311.81	$395.40