Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $253.06 / $887.50 / $4,933.00	Facility		$253.06	$887.50	$4,933.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $126.53 / $126.53 / $275.63	Facility	52	$126.53	$126.53	$275.63
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $50.61 / $50.61 / $110.25	Facility	53	$50.61	$50.61	$110.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $205.02 / $362.83 / $578.80	Professional		$205.02	$362.83	$578.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.94 / $101.59 / $126.98	Professional		$81.94	$101.59	$126.98
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 $52.47 / $198.47 / $341.32	Professional		$52.47	$198.47	$341.32
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 $411.74 / $520.40 / $733.16	Professional		$411.74	$520.40	$733.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.71 / $427.69 / $842.52	Professional		$213.71	$427.69	$842.52
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $257.61 / $887.50 / $6,895.04	Facility		$257.61	$887.50	$6,895.04
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $126.53 / $126.53 / $275.63	Facility	52	$126.53	$126.53	$275.63
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $50.61 / $50.61 / $110.25	Facility	53	$50.61	$50.61	$110.25
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $230.81 / $476.66 / $657.80	Professional		$230.81	$476.66	$657.80
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 $558.00 / $3,523.00 / $6,029.00	Facility		$558.00	$3,523.00	$6,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $433.44 / $570.17 / $778.77	Professional		$433.44	$570.17	$778.77