Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $86.90 / $175.15 / $513.86	Facility		$86.90	$175.15	$513.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.03 / $95.64 / $155.27	Professional		$57.03	$95.64	$155.27
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $197.64 / $650.03 / $650.03	Professional	50	$197.64	$650.03	$650.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.77 / $91.92 / $126.71	Professional		$65.77	$91.92	$126.71
BCBS Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $242.89 / $553.30	Facility		$169.82	$242.89	$553.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.56 / $79.58 / $126.45	Professional		$11.56	$79.58	$126.45
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $103.35 / $121.59 / $173.25	Professional	50	$103.35	$121.59	$173.25
CareSource Facility/Professional Facility Modifier Low / Median / High Price $59.69 / $74.65 / $89.54	Facility		$59.69	$74.65	$89.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $81.70 / $109.99 / $138.13	Professional		$81.70	$109.99	$138.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.30 / $87.44 / $159.90	Professional		$61.30	$87.44	$159.90
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $89.60 / $361.90 / $513.86	Facility		$89.60	$361.90	$513.86
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $77.69 / $100.78 / $150.00	Professional		$77.69	$100.78	$150.00
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $173.96 / $197.64 / $650.03	Professional	50	$173.96	$197.64	$650.03
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 $193.60 / $1,155.00 / $1,844.00	Facility		$193.60	$1,155.00	$1,844.00
United Facility/Professional Professional Modifier Low / Median / High Price $86.33 / $101.50 / $139.26	Professional		$86.33	$101.50	$139.26