Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $1,584.89 / $3,630.78	Facility		$426.58	$1,584.89	$3,630.78
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $114.82 / $165.96 / $229.09	Facility	53	$114.82	$165.96	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $346.74 / $954.99	Professional		$177.83	$346.74	$954.99
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $85.11 / $158.49 / $288.40	Professional	53	$85.11	$158.49	$288.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $199.53 / $346.74	Professional		$154.88	$199.53	$346.74
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $57.54 / $95.50 / $162.18	Professional	53	$57.54	$95.50	$162.18
BCBS Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $275.42 / $275.42	Facility		$169.82	$275.42	$275.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $295.12 / $537.03	Professional		$177.83	$295.12	$537.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.55 / $138.04 / $288.40	Facility		$24.55	$138.04	$288.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $112.20 / $501.19	Professional		$43.65	$112.20	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $363.08 / $741.31	Professional		$194.98	$363.08	$741.31
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $67.61 / $213.80 / $758.58	Professional	53	$67.61	$213.80	$758.58
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $1,513.56 / $3,548.13	Facility		$295.12	$1,513.56	$3,548.13
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $117.49 / $190.55 / $229.09	Facility	53	$117.49	$190.55	$229.09
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $363.08 / $724.44	Professional		$186.21	$363.08	$724.44
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $89.13 / $165.96 / $281.84	Professional	53	$89.13	$165.96	$281.84
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $338.84 / $691.83	Professional		$190.55	$338.84	$691.83
Priority Health Facility/Professional Professional Modifier 53 Low / Median / High Price $194.98 / $218.78 / $363.08	Professional	53	$194.98	$218.78	$363.08
United Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $2,454.71 / $5,623.41	Facility		$588.84	$2,454.71	$5,623.41
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $331.13 / $562.34	Professional		$194.98	$331.13	$562.34
United Facility/Professional Professional Modifier 53 Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	53	$218.78	$218.78	$218.78