Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $209.40 / $1,145.70 / $4,933.00	Facility		$209.40	$1,145.70	$4,933.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $104.70 / $104.70 / $256.39	Facility	52	$104.70	$104.70	$256.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.16 / $249.04 / $538.42	Professional		$162.16	$249.04	$538.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $140.50 / $185.73 / $369.46	Professional		$140.50	$185.73	$369.46
BCBS Facility/Professional Facility Modifier Low / Median / High Price $689.31 / $1,019.14 / $1,407.03	Facility		$689.31	$1,019.14	$1,407.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.73 / $153.13 / $272.52	Professional		$43.73	$153.13	$272.52
CareSource Facility/Professional Facility Modifier Low / Median / High Price $154.78 / $193.67 / $233.49	Facility		$154.78	$193.67	$233.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $382.84 / $481.50 / $681.68	Professional		$382.84	$481.50	$681.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.36 / $336.32 / $782.00	Professional		$176.36	$336.32	$782.00
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $213.16 / $1,723.15 / $4,933.00	Facility		$213.16	$1,723.15	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $104.70 / $104.70 / $256.39	Facility	52	$104.70	$104.70	$256.39
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $178.56 / $286.43 / $572.85	Professional		$178.56	$286.43	$572.85
Molina Facility/Professional Professional Modifier Low / Median / High Price $324.82 / $404.36 / $582.74	Professional		$324.82	$404.36	$582.74
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 $234.21 / $439.46 / $639.22	Professional		$234.21	$439.46	$639.22