Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $115.38 / $193.92 / $4,933.00	Facility		$115.38	$193.92	$4,933.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.37 / $158.62 / $256.85	Professional		$115.37	$158.62	$256.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.24 / $139.41 / $164.01	Professional		$138.24	$139.41	$164.01
BCBS Facility/Professional Facility Modifier Low / Median / High Price $211.93 / $247.01 / $334.66	Facility		$211.93	$247.01	$334.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.89 / $81.36 / $157.97	Professional		$19.89	$81.36	$157.97
CareSource Facility/Professional Facility Modifier Low / Median / High Price $92.39 / $101.63 / $137.22	Facility		$92.39	$101.63	$137.22
CareSource Facility/Professional Professional Modifier Low / Median / High Price $157.83 / $167.90 / $250.18	Professional		$157.83	$167.90	$250.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.51 / $151.62 / $418.67	Professional		$85.51	$151.62	$418.67
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $152.52 / $193.92 / $4,933.00	Facility		$152.52	$193.92	$4,933.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $115.37 / $172.07 / $255.65	Professional		$115.37	$172.07	$255.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $108.90 / $134.77 / $188.01	Professional		$108.90	$134.77	$188.01
United Facility/Professional Facility Modifier Low / Median / High Price $464.00 / $1,418.00 / $2,449.00	Facility		$464.00	$1,418.00	$2,449.00
United Facility/Professional Professional Modifier Low / Median / High Price $145.51 / $179.85 / $239.96	Professional		$145.51	$179.85	$239.96