Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,583.40 / $5,495.41 / $9,124.20	Facility		$1,583.40	$5,495.41	$9,124.20
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $137.47 / $143.21 / $791.70	Facility	52	$137.47	$143.21	$791.70
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $54.99 / $57.28 / $316.68	Facility	53	$54.99	$57.28	$316.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $237.38 / $368.93 / $1,583.40	Professional		$237.38	$368.93	$1,583.40
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $45.55 / $57.28 / $316.68	Professional	53	$45.55	$57.28	$316.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $240.45 / $1,209.38 / $2,018.63	Professional		$240.45	$1,209.38	$2,018.63
BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,156.97 / $4,852.45 / $6,610.38	Facility		$4,156.97	$4,852.45	$6,610.38
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.76 / $205.19 / $369.62	Professional		$58.76	$205.19	$369.62
CareSource Facility/Professional Facility Modifier Low / Median / High Price $219.31 / $296.07 / $325.73	Facility		$219.31	$296.07	$325.73
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,169.18 / $1,391.88 / $1,453.08	Professional		$1,169.18	$1,391.88	$1,453.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $212.51 / $422.05 / $2,120.73	Professional		$212.51	$422.05	$2,120.73
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $1,141.20 / $5,197.60 / $8,990.26	Facility		$1,141.20	$5,197.60	$8,990.26
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $137.47 / $137.47 / $760.03	Facility	52	$137.47	$137.47	$760.03
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $54.99 / $54.99 / $304.01	Facility	53	$54.99	$54.99	$304.01
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $274.95 / $497.12 / $1,662.57	Professional		$274.95	$497.12	$1,662.57
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $50.93 / $91.47 / $316.68	Professional	53	$50.93	$91.47	$316.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $997.35 / $1,254.46 / $1,823.41	Professional		$997.35	$1,254.46	$1,823.41
United Facility/Professional Facility Modifier Low / Median / High Price $2,750.00 / $5,819.00 / $8,339.00	Facility		$2,750.00	$5,819.00	$8,339.00
United Facility/Professional Professional Modifier Low / Median / High Price $378.43 / $649.11 / $2,119.77	Professional		$378.43	$649.11	$2,119.77