Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $445.68 / $1,669.20 / $3,373.65	Facility		$445.68	$1,669.20	$3,373.65
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $116.68 / $116.68 / $212.40	Facility	52	$116.68	$116.68	$212.40
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $84.96 / $122.51 / $212.19	Facility	53	$84.96	$122.51	$212.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.69 / $323.31 / $572.44	Professional		$186.69	$323.31	$572.44
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $46.67 / $107.59 / $212.19	Professional	53	$46.67	$107.59	$212.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.94 / $213.27 / $440.31	Professional		$169.94	$213.27	$440.31
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $50.24 / $87.59 / $136.30	Professional	53	$50.24	$87.59	$136.30
BCBS Facility/Professional Facility Modifier Low / Median / High Price $937.48 / $1,344.00 / $3,222.66	Facility		$937.48	$1,344.00	$3,222.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.39 / $177.37 / $354.76	Professional		$46.39	$177.37	$354.76
CareSource Facility/Professional Facility Modifier Low / Median / High Price $22.28 / $138.05 / $256.29	Facility		$22.28	$138.05	$256.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.29 / $227.99 / $463.29	Professional		$43.29	$227.99	$463.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $207.79 / $361.48 / $709.75	Professional		$207.79	$361.48	$709.75
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $75.09 / $188.42 / $357.87	Professional	53	$75.09	$188.42	$357.87
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $400.42 / $1,609.15 / $3,550.01	Facility		$400.42	$1,609.15	$3,550.01
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $116.68 / $116.68 / $212.40	Facility	52	$116.68	$116.68	$212.40
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $116.68 / $147.01 / $216.00	Facility	53	$116.68	$147.01	$216.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $203.61 / $399.76 / $574.00	Professional		$203.61	$399.76	$574.00
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $59.18 / $140.97 / $233.40	Professional	53	$59.18	$140.97	$233.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $147.31 / $244.97 / $379.64	Professional		$147.31	$244.97	$379.64
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 $305.95 / $468.23 / $650.11	Professional		$305.95	$468.23	$650.11
United Facility/Professional Professional Modifier 53 Low / Median / High Price $133.43 / $133.43 / $220.49	Professional	53	$133.43	$133.43	$220.49