Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $1,621.81 / $3,801.89	Facility		$354.81	$1,621.81	$3,801.89
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $208.93 / $1,380.38 / $1,380.38	Facility	52	$208.93	$1,380.38	$1,380.38
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $91.20 / $117.49 / $177.83	Facility	53	$91.20	$117.49	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $316.23 / $851.14	Professional		$169.82	$316.23	$851.14
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $72.44 / $125.89 / $218.78	Professional	53	$72.44	$125.89	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $181.97 / $309.03	Professional		$165.96	$181.97	$309.03
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $81.28 / $134.90 / $165.96	Professional	53	$81.28	$134.90	$165.96
BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $169.82 / $169.82	Facility		$54.95	$169.82	$169.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $295.12 / $537.03	Professional		$169.82	$295.12	$537.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.55 / $138.04 / $288.40	Facility		$24.55	$138.04	$288.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $112.20 / $501.19	Professional		$43.65	$112.20	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $478.63	Professional		$302.00	$302.00	$478.63
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.69 / $147.91 / $363.08	Professional	53	$41.69	$147.91	$363.08
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $1,513.56 / $3,630.78	Facility		$338.84	$1,513.56	$3,630.78
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $208.93 / $1,380.38 / $1,380.38	Facility	52	$208.93	$1,380.38	$1,380.38
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $91.20 / $165.96 / $354.81	Facility	53	$91.20	$165.96	$354.81
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $331.13 / $660.69	Professional		$177.83	$331.13	$660.69
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $77.62 / $147.91 / $245.47	Professional	53	$77.62	$147.91	$245.47
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $457.09	Professional		$302.00	$302.00	$457.09
Priority Health Facility/Professional Professional Modifier 53 Low / Median / High Price $147.91 / $194.98 / $363.08	Professional	53	$147.91	$194.98	$363.08
United Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $1,995.26 / $4,073.80	Facility		$436.52	$1,995.26	$4,073.80
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $331.13 / $562.34	Professional		$194.98	$331.13	$562.34
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	53	$204.17	$204.17	$204.17