Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.11 / $2,056.00 / $4,836.37	Facility		$114.11	$2,056.00	$4,836.37
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $45.29 / $45.29 / $175.92	Facility	52	$45.29	$45.29	$175.92
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $18.11 / $18.11 / $70.37	Facility	53	$18.11	$18.11	$70.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.68 / $125.42 / $351.83	Professional		$65.68	$125.42	$351.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.81 / $68.73 / $125.41	Professional		$36.81	$68.73	$125.41
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,167.72 / $1,726.48 / $2,314.30	Facility		$1,167.72	$1,726.48	$2,314.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.10 / $81.05 / $140.47	Professional		$19.10	$81.05	$140.47
CareSource Facility/Professional Facility Modifier Low / Median / High Price $67.86 / $84.93 / $102.05	Facility		$67.86	$84.93	$102.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $264.00 / $328.46 / $474.00	Professional		$264.00	$328.46	$474.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.34 / $172.51 / $532.89	Professional		$76.34	$172.51	$532.89
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $142.81 / $2,056.00 / $4,836.37	Facility		$142.81	$2,056.00	$4,836.37
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $45.29 / $45.29 / $175.92	Facility	52	$45.29	$45.29	$175.92
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $18.11 / $18.11 / $70.37	Facility	53	$18.11	$18.11	$70.37
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $69.51 / $169.15 / $369.42	Professional		$69.51	$169.15	$369.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $215.91 / $269.70 / $389.04	Professional		$215.91	$269.70	$389.04
United Facility/Professional Facility Modifier Low / Median / High Price $645.00 / $3,005.00 / $4,504.00	Facility		$645.00	$3,005.00	$4,504.00
United Facility/Professional Professional Modifier Low / Median / High Price $199.61 / $296.70 / $442.70	Professional		$199.61	$296.70	$442.70