Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $540.49 / $1,994.92 / $3,569.90	Facility		$540.49	$1,994.92	$3,569.90
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $126.77 / $270.25 / $1,044.48	Facility	52	$126.77	$270.25	$1,044.48
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $50.71 / $108.10 / $801.09	Facility	53	$50.71	$108.10	$801.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.24 / $412.64 / $704.93	Professional		$221.24	$412.64	$704.93
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $100.85 / $199.77 / $270.25	Professional	52	$100.85	$199.77	$270.25
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $39.14 / $74.72 / $108.10	Professional	53	$39.14	$74.72	$108.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $174.27 / $206.50 / $284.79	Professional		$174.27	$206.50	$284.79
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $43.49 / $71.20 / $71.20	Professional	52	$43.49	$71.20	$71.20
BCBS Facility/Professional Facility Modifier Low / Median / High Price $864.10 / $1,277.57 / $1,712.54	Facility		$864.10	$1,277.57	$1,712.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.97 / $231.86 / $371.00	Professional		$52.97	$231.86	$371.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $187.73 / $234.66 / $283.85	Facility		$187.73	$234.66	$283.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $403.91 / $510.83 / $719.01	Professional		$403.91	$510.83	$719.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $221.46 / $444.91 / $866.94	Professional		$221.46	$444.91	$866.94
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $494.52 / $1,959.06 / $5,603.52	Facility		$494.52	$1,959.06	$5,603.52
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $126.77 / $270.25 / $1,044.48	Facility	52	$126.77	$270.25	$1,044.48
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $50.71 / $108.10 / $3,935.06	Facility	53	$50.71	$108.10	$3,935.06
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $243.12 / $478.98 / $702.63	Professional		$243.12	$478.98	$702.63
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $106.06 / $199.77 / $328.40	Professional	52	$106.06	$199.77	$328.40
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $40.34 / $69.80 / $108.10	Professional	53	$40.34	$69.80	$108.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $353.68 / $439.27 / $632.23	Professional		$353.68	$439.27	$632.23
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 $436.68 / $571.58 / $774.41	Professional		$436.68	$571.58	$774.41