Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $333.29 / $1,368.25 / $3,372.98	Facility		$333.29	$1,368.25	$3,372.98
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $91.55 / $166.65 / $1,370.00	Facility	52	$91.55	$166.65	$1,370.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $66.66 / $97.06 / $168.12	Facility	53	$66.66	$97.06	$168.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.03 / $291.93 / $552.29	Professional		$180.03	$291.93	$552.29
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $36.97 / $91.54 / $171.78	Professional	53	$36.97	$91.54	$171.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $174.51 / $242.78 / $319.74	Professional		$174.51	$242.78	$319.74
BCBS Facility/Professional Facility Modifier Low / Median / High Price $937.48 / $1,344.00 / $3,222.66	Facility		$937.48	$1,344.00	$3,222.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.39 / $177.37 / $303.52	Professional		$46.39	$177.37	$303.52
CareSource Facility/Professional Facility Modifier Low / Median / High Price $22.17 / $138.05 / $256.29	Facility		$22.17	$138.05	$256.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.20 / $283.27 / $463.29	Professional		$43.20	$283.27	$463.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $288.39 / $301.45 / $488.61	Professional		$288.39	$301.45	$488.61
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $75.09 / $174.41 / $242.52	Professional	53	$75.09	$174.41	$242.52
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $336.56 / $1,605.06 / $3,388.56	Facility		$336.56	$1,605.06	$3,388.56
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $91.55 / $209.00 / $1,370.00	Facility	52	$91.55	$209.00	$1,370.00
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $91.54 / $140.97 / $171.14	Facility	53	$91.54	$140.97	$171.14
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $183.09 / $336.56 / $569.60	Professional		$183.09	$336.56	$569.60
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $54.93 / $140.97 / $209.79	Professional	53	$54.93	$140.97	$209.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $147.31 / $244.97 / $379.64	Professional		$147.31	$244.97	$379.64
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 $339.60 / $471.28 / $647.66	Professional		$339.60	$471.28	$647.66
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.61 / $204.61 / $204.61	Professional	53	$204.61	$204.61	$204.61