Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $152.63 / $1,677.54 / $3,155.63	Facility		$152.63	$1,677.54	$3,155.63
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $991.71 / $2,056.00 / $4,310.28	Facility	50	$991.71	$2,056.00	$4,310.28
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $28.00 / $29.08 / $63.17	Facility	53	$28.00	$29.08	$63.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $237.80 / $503.63	Professional		$95.09	$237.80	$503.63
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $178.98 / $377.56 / $1,334.00	Professional	50	$178.98	$377.56	$1,334.00
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $20.85 / $40.49 / $63.17	Professional	53	$20.85	$40.49	$63.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $111.04 / $237.66 / $399.49	Professional		$111.04	$237.66	$399.49
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $166.56 / $318.58 / $599.24	Professional	50	$166.56	$318.58	$599.24
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,081.71 / $1,460.65 / $3,430.15	Facility		$1,081.71	$1,460.65	$3,430.15
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $579.62 / $889.75 / $1,158.16	Facility	50	$579.62	$889.75	$1,158.16
BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.19 / $157.54 / $286.06	Professional		$28.19	$157.54	$286.06
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $266.04 / $266.04 / $583.20	Professional	50	$266.04	$266.04	$583.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $103.77 / $130.29 / $155.66	Facility		$103.77	$130.29	$155.66
CareSource Facility/Professional Professional Modifier Low / Median / High Price $220.24 / $288.52 / $441.79	Professional		$220.24	$288.52	$441.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.08 / $190.98 / $414.56	Professional		$98.08	$190.98	$414.56
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $236.71 / $1,760.46 / $3,113.38	Facility		$236.71	$1,760.46	$3,113.38
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $991.71 / $2,617.46 / $4,310.28	Facility	50	$991.71	$2,617.46	$4,310.28
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $28.00 / $28.00 / $60.83	Facility	53	$28.00	$28.00	$60.83
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $119.49 / $239.71 / $418.76	Professional		$119.49	$239.71	$418.76
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $179.24 / $458.91 / $1,282.50	Professional	50	$179.24	$458.91	$1,282.50
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $28.00 / $47.10 / $74.18	Professional	53	$28.00	$47.10	$74.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $190.70 / $236.99 / $335.79	Professional		$190.70	$236.99	$335.79
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 $228.14 / $292.01 / $395.63	Professional		$228.14	$292.01	$395.63