Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $74.31 / $1,626.73 / $2,555.94	Facility		$74.31	$1,626.73	$2,555.94
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $35.40 / $35.40 / $114.46	Facility	52	$35.40	$35.40	$114.46
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $14.16 / $14.16 / $45.78	Facility	53	$14.16	$14.16	$45.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.31 / $126.53 / $240.35	Professional		$55.31	$126.53	$240.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.04 / $58.08 / $181.19	Professional		$29.04	$58.08	$181.19
BCBS Facility/Professional Facility Modifier Low / Median / High Price $935.02 / $1,382.44 / $1,908.59	Facility		$935.02	$1,382.44	$1,908.59
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.13 / $44.07 / $74.69	Professional		$11.13	$44.07	$74.69
CareSource Facility/Professional Facility Modifier Low / Median / High Price $53.32 / $66.66 / $80.12	Facility		$53.32	$66.66	$80.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $174.72 / $218.03 / $314.08	Professional		$174.72	$218.03	$314.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.47 / $133.60 / $342.88	Professional		$60.47	$133.60	$342.88
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $140.97 / $1,652.73 / $4,588.83	Facility		$140.97	$1,652.73	$4,588.83
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $35.40 / $35.40 / $114.46	Facility	52	$35.40	$35.40	$114.46
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $14.16 / $14.16 / $45.78	Facility	53	$14.16	$14.16	$45.78
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $65.09 / $140.97 / $244.19	Professional		$65.09	$140.97	$244.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $162.82 / $202.06 / $291.43	Professional		$162.82	$202.06	$291.43
United Facility/Professional Facility Modifier Low / Median / High Price $645.00 / $2,704.00 / $4,504.00	Facility		$645.00	$2,704.00	$4,504.00
United Facility/Professional Professional Modifier Low / Median / High Price $152.77 / $197.70 / $284.70	Professional		$152.77	$197.70	$284.70