Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $72.61 / $957.53 / $4,933.00	Facility		$72.61	$957.53	$4,933.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.89 / $79.81 / $150.07	Professional		$48.89	$79.81	$150.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $113.18 / $150.71 / $232.96	Professional	50	$113.18	$150.71	$232.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $49.95 / $89.74 / $112.18	Professional		$49.95	$89.74	$112.18
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $125.31 / $174.99 / $174.99	Professional	50	$125.31	$174.99	$174.99
BCBS Facility/Professional Facility Modifier Low / Median / High Price $937.11 / $1,265.40 / $2,971.63	Facility		$937.11	$1,265.40	$2,971.63
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $535.92 / $761.01 / $963.52	Facility	50	$535.92	$761.01	$963.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.42 / $64.31 / $105.67	Professional		$9.42	$64.31	$105.67
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $83.54 / $98.28 / $170.10	Professional	50	$83.54	$98.28	$170.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $49.36 / $62.43 / $74.91	Facility		$49.36	$62.43	$74.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $81.20 / $108.60 / $168.36	Professional		$81.20	$108.60	$168.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.35 / $85.24 / $147.25	Professional		$52.35	$85.24	$147.25
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $75.84 / $1,196.91 / $2,878.00	Facility		$75.84	$1,196.91	$2,878.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $63.36 / $87.91 / $147.77	Professional		$63.36	$87.91	$147.77
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $150.71 / $225.56 / $232.96	Professional	50	$150.71	$225.56	$232.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.79 / $101.78 / $144.21	Professional		$81.79	$101.78	$144.21
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 $81.19 / $102.06 / $129.43	Professional		$81.19	$102.06	$129.43