Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.61 / $397.09 / $2,056.00	Facility		$69.61	$397.09	$2,056.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $939.78 / $1,502.28 / $1,965.37	Facility	50	$939.78	$1,502.28	$1,965.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.57 / $59.08 / $117.73	Professional		$37.57	$59.08	$117.73
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $111.52 / $114.45 / $325.98	Professional	50	$111.52	$114.45	$325.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $49.46 / $54.89 / $77.91	Professional		$49.46	$54.89	$77.91
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $52.58 / $82.34 / $116.87	Professional	50	$52.58	$82.34	$116.87
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 $226.14 / $312.20 / $423.38	Facility	50	$226.14	$312.20	$423.38
BCBS Facility/Professional Professional Modifier Low / Median / High Price $6.79 / $41.04 / $72.06	Professional		$6.79	$41.04	$72.06
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $58.91 / $69.30 / $103.95	Professional	50	$58.91	$69.30	$103.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $34.69 / $43.66 / $52.40	Facility		$34.69	$43.66	$52.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $49.79 / $66.64 / $103.54	Professional		$49.79	$66.64	$103.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.86 / $53.40 / $97.63	Professional		$36.86	$53.40	$97.63
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $56.99 / $491.34 / $2,056.00	Facility		$56.99	$491.34	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $939.78 / $1,502.28 / $1,965.37	Facility	50	$939.78	$1,502.28	$1,965.37
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $62.45 / $104.47	Professional		$47.00	$62.45	$104.47
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $111.52 / $114.45 / $198.08	Professional	50	$111.52	$114.45	$198.08
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 $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 $51.08 / $65.73 / $90.39	Professional		$51.08	$65.73	$90.39