Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $72.56 / $283.61 / $4,933.00	Facility		$72.56	$283.61	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $157.11 / $718.84 / $718.84	Facility	50	$157.11	$718.84	$718.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.90 / $82.60 / $143.05	Professional		$51.90	$82.60	$143.05
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $108.90 / $166.47 / $297.83	Professional	50	$108.90	$166.47	$297.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.79 / $84.04 / $116.60	Professional		$50.79	$84.04	$116.60
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $88.26 / $126.06 / $126.06	Professional	50	$88.26	$126.06	$126.06
BCBS Facility/Professional Facility Modifier Low / Median / High Price $392.68 / $460.89 / $624.42	Facility		$392.68	$460.89	$624.42
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $248.19 / $289.12 / $423.38	Facility	50	$248.19	$289.12	$423.38
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.27 / $61.36 / $105.77	Professional		$12.27	$61.36	$105.77
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $91.57 / $133.88 / $157.50	Professional	50	$91.57	$133.88	$157.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $53.73 / $67.89 / $81.47	Facility		$53.73	$67.89	$81.47
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.84 / $101.05 / $157.26	Professional		$74.84	$101.05	$157.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.73 / $78.80 / $147.01	Professional		$54.73	$78.80	$147.01
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $73.20 / $293.89 / $4,933.00	Facility		$73.20	$293.89	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $157.11 / $718.84 / $718.84	Facility	50	$157.11	$718.84	$718.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $69.53 / $88.35 / $137.01	Professional		$69.53	$88.35	$137.01
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $143.94 / $182.16 / $299.25	Professional	50	$143.94	$182.16	$299.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.68 / $68.01 / $96.85	Professional		$54.68	$68.01	$96.85
United Facility/Professional Facility Modifier Low / Median / High Price $215.18 / $1,155.00 / $1,844.00	Facility		$215.18	$1,155.00	$1,844.00
United Facility/Professional Professional Modifier Low / Median / High Price $76.68 / $90.86 / $124.94	Professional		$76.68	$90.86	$124.94