Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $292.58 / $1,398.04 / $3,355.09	Facility		$292.58	$1,398.04	$3,355.09
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $25.11 / $26.08 / $66.25	Facility	53	$25.11	$26.08	$66.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.12 / $224.93 / $433.34	Professional		$94.12	$224.93	$433.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $99.74 / $248.36 / $416.63	Professional		$99.74	$248.36	$416.63
BCBS Facility/Professional Facility Modifier Low / Median / High Price $627.37 / $910.60 / $2,189.07	Facility		$627.37	$910.60	$2,189.07
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.14 / $147.90 / $199.67	Professional		$25.14	$147.90	$199.67
CareSource Facility/Professional Facility Modifier Low / Median / High Price $93.37 / $116.80 / $140.16	Facility		$93.37	$116.80	$140.16
CareSource Facility/Professional Professional Modifier Low / Median / High Price $229.69 / $300.89 / $460.14	Professional		$229.69	$300.89	$460.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.49 / $188.46 / $452.65	Professional		$87.49	$188.46	$452.65
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $165.72 / $1,460.55 / $2,878.00	Facility		$165.72	$1,460.55	$2,878.00
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $25.11 / $25.11 / $63.80	Facility	53	$25.11	$25.11	$63.80
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $103.09 / $236.10 / $436.00	Professional		$103.09	$236.10	$436.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $217.81 / $271.83 / $392.06	Professional		$217.81	$271.83	$392.06
United Facility/Professional Facility Modifier Low / Median / High Price $645.00 / $3,005.00 / $4,504.00	Facility		$645.00	$3,005.00	$4,504.00
United Facility/Professional Professional Modifier Low / Median / High Price $243.83 / $299.08 / $407.07	Professional		$243.83	$299.08	$407.07