Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $161.25 / $996.80 / $6,027.53	Facility		$161.25	$996.80	$6,027.53
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $51.05 / $51.05 / $148.37	Facility	52	$51.05	$51.05	$148.37
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $20.42 / $20.42 / $59.35	Facility	53	$20.42	$20.42	$59.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.09 / $233.40 / $377.06	Professional		$102.09	$233.40	$377.06
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $41.14 / $87.19 / $148.37	Professional	52	$41.14	$87.19	$148.37
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $16.46 / $34.88 / $59.35	Professional	53	$16.46	$34.88	$59.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.62 / $308.39 / $396.27	Professional		$87.62	$308.39	$396.27
BCBS Facility/Professional Facility Modifier Low / Median / High Price $984.10 / $1,338.16 / $3,142.50	Facility		$984.10	$1,338.16	$3,142.50
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.81 / $119.02 / $160.68	Professional		$23.81	$119.02	$160.68
CareSource Facility/Professional Facility Modifier Low / Median / High Price $75.54 / $101.98 / $112.20	Facility		$75.54	$101.98	$112.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $207.74 / $247.31 / $260.16	Professional		$207.74	$247.31	$260.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.78 / $204.11 / $330.63	Professional		$81.78	$204.11	$330.63
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $257.20 / $1,149.72 / $5,251.35	Facility		$257.20	$1,149.72	$5,251.35
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $51.05 / $51.05 / $148.37	Facility	52	$51.05	$51.05	$148.37
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $20.42 / $20.42 / $59.35	Facility	53	$20.42	$20.42	$59.35
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $102.09 / $229.60 / $376.71	Professional		$102.09	$229.60	$376.71
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $48.90 / $87.19 / $148.37	Professional	52	$48.90	$87.19	$148.37
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $19.55 / $34.88 / $59.35	Professional	53	$19.55	$34.88	$59.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $190.70 / $238.43 / $341.35	Professional		$190.70	$238.43	$341.35
United Facility/Professional Facility Modifier Low / Median / High Price $773.00 / $2,531.00 / $4,504.00	Facility		$773.00	$2,531.00	$4,504.00
United Facility/Professional Professional Modifier Low / Median / High Price $220.45 / $266.63 / $366.19	Professional		$220.45	$266.63	$366.19