Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $115.34 / $1,937.62 / $3,816.70	Facility		$115.34	$1,937.62	$3,816.70
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $55.61 / $245.45 / $254.54	Facility	52	$55.61	$245.45	$254.54
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $22.24 / $23.07 / $101.81	Facility	53	$22.24	$23.07	$101.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.20 / $199.16 / $509.07	Professional		$79.20	$199.16	$509.07
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,538.21 / $2,101.11 / $4,841.63	Facility		$1,538.21	$2,101.11	$4,841.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $20.82 / $80.40 / $136.26	Professional		$20.82	$80.40	$136.26
CareSource Facility/Professional Facility Modifier Low / Median / High Price $78.06 / $105.38 / $115.94	Facility		$78.06	$105.38	$115.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $345.82 / $345.82 / $411.69	Professional		$345.82	$345.82	$411.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.32 / $172.70 / $697.96	Professional		$89.32	$172.70	$697.96
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $145.32 / $1,796.06 / $4,933.00	Facility		$145.32	$1,796.06	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $55.61 / $245.45 / $756.00	Facility	52	$55.61	$245.45	$756.00
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $22.24 / $22.24 / $98.18	Facility	53	$22.24	$22.24	$98.18
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $111.22 / $388.25 / $517.72	Professional		$111.22	$388.25	$517.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $303.01 / $377.43 / $538.45	Professional		$303.01	$377.43	$538.45
United Facility/Professional Facility Modifier Low / Median / High Price $1,527.00 / $3,640.00 / $6,740.00	Facility		$1,527.00	$3,640.00	$6,740.00
United Facility/Professional Professional Modifier Low / Median / High Price $446.53 / $513.38 / $694.31	Professional		$446.53	$513.38	$694.31