Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $419.73 / $2,877.00 / $4,933.00	Facility		$419.73	$2,877.00	$4,933.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $209.87 / $209.87 / $209.87	Facility	52	$209.87	$209.87	$209.87
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $83.95 / $83.95 / $83.95	Facility	53	$83.95	$83.95	$83.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $324.05 / $472.50 / $595.35	Professional		$324.05	$472.50	$595.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $432.50 / $432.50 / $610.51	Professional		$432.50	$432.50	$610.51
BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,008.88 / $2,880.00 / $6,905.70	Facility		$2,008.88	$2,880.00	$6,905.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.96 / $463.62 / $542.83	Professional		$82.96	$463.62	$542.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $308.97 / $386.71 / $466.55	Facility		$308.97	$386.71	$466.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $312.33 / $408.86 / $541.71	Professional		$312.33	$408.86	$541.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $267.87 / $447.22 / $958.46	Professional		$267.87	$447.22	$958.46
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $419.73 / $2,577.04 / $4,933.00	Facility		$419.73	$2,577.04	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $209.87 / $209.87 / $209.87	Facility	52	$209.87	$209.87	$209.87
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $83.95 / $83.95 / $83.95	Facility	53	$83.95	$83.95	$83.95
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $167.54 / $401.25 / $741.18	Professional		$167.54	$401.25	$741.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $272.36 / $344.91 / $490.24	Professional		$272.36	$344.91	$490.24
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 $346.10 / $456.23 / $608.15	Professional		$346.10	$456.23	$608.15