Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.10 / $307.66 / $2,056.00	Facility		$93.10	$307.66	$2,056.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $37.65 / $39.22 / $61.99	Facility	52	$37.65	$39.22	$61.99
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $15.06 / $24.79 / $311.69	Facility	53	$15.06	$24.79	$311.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.30 / $112.43 / $209.31	Professional		$75.30	$112.43	$209.31
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.46 / $43.63 / $61.99	Professional	52	$31.46	$43.63	$61.99
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $13.45 / $20.01 / $36.34	Professional	53	$13.45	$20.01	$36.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.83 / $79.80 / $171.03	Professional		$55.83	$79.80	$171.03
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $131.82 / $131.82 / $131.82	Professional	53	$131.82	$131.82	$131.82
BCBS Facility/Professional Facility Modifier Low / Median / High Price $170.28 / $198.76 / $270.77	Facility		$170.28	$198.76	$270.77
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.47 / $64.11 / $100.20	Professional		$11.47	$64.11	$100.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $59.97 / $80.95 / $89.07	Facility		$59.97	$80.95	$89.07
CareSource Facility/Professional Professional Modifier Low / Median / High Price $94.49 / $112.49 / $122.04	Professional		$94.49	$112.49	$122.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.22 / $103.31 / $169.75	Professional		$58.22	$103.31	$169.75
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $93.10 / $307.66 / $2,056.00	Facility		$93.10	$307.66	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $37.65 / $37.65 / $59.51	Facility	52	$37.65	$37.65	$59.51
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $15.06 / $311.69 / $311.69	Facility	53	$15.06	$311.69	$311.69
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $78.43 / $117.34 / $189.00	Professional		$78.43	$117.34	$189.00
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $34.86 / $50.43 / $62.63	Professional	52	$34.86	$50.43	$62.63
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $15.06 / $24.79 / $39.64	Professional	53	$15.06	$24.79	$39.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.79 / $102.47 / $146.41	Professional		$81.79	$102.47	$146.41
United Facility/Professional Facility Modifier Low / Median / High Price $464.00 / $1,428.00 / $2,029.00	Facility		$464.00	$1,428.00	$2,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $114.19 / $139.55 / $176.88	Professional		$114.19	$139.55	$176.88