Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $357.62 / $1,564.79 / $3,542.87	Facility		$357.62	$1,564.79	$3,542.87
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $77.28 / $77.28 / $178.82	Facility	52	$77.28	$77.28	$178.82
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $30.91 / $30.91 / $71.53	Facility	53	$30.91	$30.91	$71.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.38 / $221.54 / $411.27	Professional		$120.38	$221.54	$411.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.78 / $167.33 / $231.72	Professional		$68.78	$167.33	$231.72
BCBS Facility/Professional Facility Modifier Low / Median / High Price $695.33 / $1,028.04 / $1,378.06	Facility		$695.33	$1,028.04	$1,378.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $119.28 / $245.38	Professional		$30.90	$119.28	$245.38
CareSource Facility/Professional Facility Modifier Low / Median / High Price $114.64 / $143.40 / $172.82	Facility		$114.64	$143.40	$172.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $268.95 / $338.70 / $479.33	Professional		$268.95	$338.70	$479.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $132.00 / $280.00 / $567.16	Professional		$132.00	$280.00	$567.16
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $334.12 / $1,653.62 / $4,428.22	Facility		$334.12	$1,653.62	$4,428.22
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $77.28 / $77.28 / $178.82	Facility	52	$77.28	$77.28	$178.82
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $30.91 / $30.91 / $71.53	Facility	53	$30.91	$30.91	$71.53
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $126.29 / $302.23 / $450.61	Professional		$126.29	$302.23	$450.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $216.54 / $269.57 / $388.49	Professional		$216.54	$269.57	$388.49
United Facility/Professional Facility Modifier Low / Median / High Price $1,050.00 / $4,857.00 / $6,036.00	Facility		$1,050.00	$4,857.00	$6,036.00
United Facility/Professional Professional Modifier Low / Median / High Price $288.00 / $373.45 / $490.95	Professional		$288.00	$373.45	$490.95