Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.95 / $423.75 / $2,056.00	Facility		$79.95	$423.75	$2,056.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $418.00 / $1,248.58 / $2,355.91	Facility	50	$418.00	$1,248.58	$2,355.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.68 / $96.06 / $224.38	Professional		$57.68	$96.06	$224.38
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $123.26 / $154.18 / $261.14	Professional	50	$123.26	$154.18	$261.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.68 / $92.34 / $138.51	Professional		$56.68	$92.34	$138.51
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $91.28 / $149.16 / $193.91	Professional	50	$91.28	$149.16	$193.91
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 $211.89 / $312.20 / $407.18	Facility	50	$211.89	$312.20	$407.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.78 / $69.51 / $115.97	Professional		$10.78	$69.51	$115.97
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $94.78 / $111.51 / $187.74	Professional	50	$94.78	$111.51	$187.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $55.96 / $70.88 / $85.05	Facility		$55.96	$70.88	$85.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $89.39 / $120.04 / $150.88	Professional		$89.39	$120.04	$150.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.55 / $95.12 / $171.21	Professional		$59.55	$95.12	$171.21
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $81.38 / $531.92 / $2,056.00	Facility		$81.38	$531.92	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $415.00 / $443.43 / $2,355.91	Facility	50	$415.00	$443.43	$2,355.91
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $72.84 / $101.61 / $166.21	Professional		$72.84	$101.61	$166.21
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $96.06 / $166.14 / $375.69	Professional	50	$96.06	$166.14	$375.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.79 / $102.07 / $144.21	Professional		$81.79	$102.07	$144.21
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 $92.61 / $117.17 / $147.58	Professional		$92.61	$117.17	$147.58