Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.06 / $543.66 / $4,933.00	Facility		$61.06	$543.66	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,379.78 / $2,379.78 / $2,379.78	Facility	50	$2,379.78	$2,379.78	$2,379.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.71 / $68.48 / $135.32	Professional		$42.71	$68.48	$135.32
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $84.65 / $139.16 / $213.81	Professional	50	$84.65	$139.16	$213.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.34 / $83.06 / $107.98	Professional		$64.34	$83.06	$107.98
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $124.60 / $124.60 / $161.97	Professional	50	$124.60	$124.60	$161.97
BCBS Facility/Professional Facility Modifier Low / Median / High Price $395.43 / $533.96 / $1,253.93	Facility		$395.43	$533.96	$1,253.93
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $213.04 / $325.26 / $407.18	Facility	50	$213.04	$325.26	$407.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.84 / $60.72 / $102.35	Professional		$9.84	$60.72	$102.35
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $74.43 / $87.57 / $157.50	Professional	50	$74.43	$87.57	$157.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $44.00 / $55.70 / $66.84	Facility		$44.00	$55.70	$66.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $75.11 / $100.43 / $155.55	Professional		$75.11	$100.43	$155.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.67 / $76.33 / $131.33	Professional		$46.67	$76.33	$131.33
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $68.39 / $1,189.19 / $4,933.00	Facility		$68.39	$1,189.19	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $2,379.78 / $2,379.78 / $2,379.78	Facility	50	$2,379.78	$2,379.78	$2,379.78
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $58.79 / $78.54 / $133.51	Professional		$58.79	$78.54	$133.51
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $84.65 / $139.16 / $213.81	Professional	50	$84.65	$139.16	$213.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.68 / $67.99 / $96.85	Professional		$54.68	$67.99	$96.85
United Facility/Professional Facility Modifier Low / Median / High Price $300.00 / $1,418.00 / $2,029.00	Facility		$300.00	$1,418.00	$2,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $73.86 / $91.87 / $118.90	Professional		$73.86	$91.87	$118.90