Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $1,122.02 / $3,981.07	Facility		$199.53	$1,122.02	$3,981.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $204.17 / $549.54	Professional		$66.07	$204.17	$549.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $147.91 / $275.42 / $1,148.15	Professional	50	$147.91	$275.42	$1,148.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $95.50 / $218.78	Professional		$79.43	$95.50	$218.78
BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $151.36 / $151.36	Facility		$100.00	$151.36	$151.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $107.15 / $354.81	Professional		$63.10	$107.15	$354.81
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $162.18 / $218.78 / $537.03	Professional	50	$162.18	$218.78	$537.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $79.43 / $91.20	Facility		$48.98	$79.43	$91.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $275.42 / $323.59	Professional		$194.98	$275.42	$323.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $114.82 / $114.82	Facility		$114.82	$114.82	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $190.55 / $478.63	Professional		$72.44	$190.55	$478.63
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $1,122.02 / $3,890.45	Facility		$281.84	$1,122.02	$3,890.45
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $213.80 / $467.74	Professional		$70.79	$213.80	$467.74
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $131.83 / $630.96 / $1,148.15	Professional	50	$131.83	$630.96	$1,148.15
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $114.82 / $114.82	Facility		$114.82	$114.82	$114.82
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $181.97 / $416.87	Professional		$67.61	$181.97	$416.87
United Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $1,258.93 / $2,041.74	Facility		$467.74	$1,258.93	$2,041.74
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $190.55 / $309.03	Professional		$72.44	$190.55	$309.03