Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.28 / $154.60 / $332.26	Facility		$35.28	$154.60	$332.26
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $240.24 / $240.24 / $498.00	Facility	50	$240.24	$240.24	$498.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.97 / $46.34 / $92.36	Professional		$30.97	$46.34	$92.36
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $73.68 / $81.77 / $81.77	Professional	50	$73.68	$81.77	$81.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $13.30 / $58.90 / $62.00	Professional		$13.30	$58.90	$62.00
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $93.00 / $93.00 / $93.00	Professional	50	$93.00	$93.00	$93.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $169.05 / $242.47 / $555.21	Facility		$169.05	$242.47	$555.21
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $133.05 / $167.38 / $226.97	Facility	50	$133.05	$167.38	$226.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $4.80 / $28.30 / $55.14	Professional		$4.80	$28.30	$55.14
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $49.14 / $101.21 / $119.07	Professional	50	$49.14	$101.21	$119.07
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.80 / $31.40 / $37.68	Facility		$24.80	$31.40	$37.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $56.91 / $75.13 / $94.72	Professional		$56.91	$75.13	$94.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.05 / $49.94 / $96.32	Professional		$26.05	$49.94	$96.32
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $35.28 / $154.60 / $332.26	Facility		$35.28	$154.60	$332.26
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $240.24 / $316.31 / $498.00	Facility	50	$240.24	$316.31	$498.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $33.96 / $53.86 / $94.86	Professional		$33.96	$53.86	$94.86
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $73.68 / $81.77 / $130.46	Professional	50	$73.68	$81.77	$130.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.68 / $68.01 / $96.85	Professional		$54.68	$68.01	$96.85
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 $54.71 / $64.95 / $86.22	Professional		$54.71	$64.95	$86.22