Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $336.93 / $1,685.38 / $3,007.50	Facility		$336.93	$1,685.38	$3,007.50
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $91.73 / $168.47 / $1,438.50	Facility	52	$91.73	$168.47	$1,438.50
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $66.73 / $112.57 / $176.92	Facility	53	$66.73	$112.57	$176.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.87 / $290.45 / $556.34	Professional		$179.87	$290.45	$556.34
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $37.04 / $91.92 / $172.11	Professional	53	$37.04	$91.92	$172.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $174.89 / $243.50 / $314.80	Professional		$174.89	$243.50	$314.80
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $90.53 / $166.69 / $175.18	Professional	53	$90.53	$166.69	$175.18
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 $48.34 / $184.54 / $304.10	Professional		$48.34	$184.54	$304.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $22.28 / $138.32 / $256.80	Facility		$22.28	$138.32	$256.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.29 / $227.99 / $463.74	Professional		$43.29	$227.99	$463.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $269.18 / $301.75 / $498.82	Professional		$269.18	$301.75	$498.82
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $75.09 / $174.72 / $365.88	Professional	53	$75.09	$174.72	$365.88
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $335.61 / $1,734.94 / $3,078.53	Facility		$335.61	$1,734.94	$3,078.53
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $91.73 / $1,370.00 / $1,438.50	Facility	52	$91.73	$1,370.00	$1,438.50
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $91.92 / $140.97 / $200.45	Facility	53	$91.92	$140.97	$200.45
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $183.46 / $336.93 / $572.66	Professional		$183.46	$336.93	$572.66
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $55.06 / $140.97 / $208.76	Professional	53	$55.06	$140.97	$208.76
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 $341.68 / $485.53 / $679.06	Professional		$341.68	$485.53	$679.06
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.84 / $204.84 / $204.84	Professional	53	$204.84	$204.84	$204.84