Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.18 / $939.64 / $3,355.09	Facility		$109.18	$939.64	$3,355.09
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,002.77 / $2,724.69 / $3,355.09	Facility	50	$1,002.77	$2,724.69	$3,355.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.23 / $164.69 / $284.44	Professional		$64.23	$164.69	$284.44
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $100.17 / $287.00 / $540.00	Professional	50	$100.17	$287.00	$540.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $38.69 / $147.27 / $161.28	Professional		$38.69	$147.27	$161.28
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $116.06 / $241.92 / $406.38	Professional	50	$116.06	$241.92	$406.38
BCBS Facility/Professional Facility Modifier Low / Median / High Price $991.03 / $1,163.18 / $1,575.92	Facility		$991.03	$1,163.18	$1,575.92
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $626.36 / $729.67 / $1,026.09	Facility	50	$626.36	$729.67	$1,026.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.17 / $118.27 / $222.73	Professional		$21.17	$118.27	$222.73
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $169.77 / $334.10 / $393.06	Professional	50	$169.77	$334.10	$393.06
CareSource Facility/Professional Facility Modifier Low / Median / High Price $78.52 / $98.25 / $117.90	Facility		$78.52	$98.25	$117.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $148.35 / $195.66 / $300.89	Professional		$148.35	$195.66	$300.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.18 / $144.56 / $293.76	Professional		$78.18	$144.56	$293.76
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $109.18 / $1,314.46 / $3,355.09	Facility		$109.18	$1,314.46	$3,355.09
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $915.76 / $2,628.92 / $3,355.09	Facility	50	$915.76	$2,628.92	$3,355.09
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $104.53 / $171.71 / $280.06	Professional		$104.53	$171.71	$280.06
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $95.40 / $393.48 / $540.00	Professional	50	$95.40	$393.48	$540.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $108.71 / $135.73 / $192.57	Professional		$108.71	$135.73	$192.57
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 $161.47 / $200.34 / $289.04	Professional		$161.47	$200.34	$289.04