Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $80.16 / $236.57 / $2,056.00	Facility		$80.16	$236.57	$2,056.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $250.90 / $371.20 / $488.78	Facility	50	$250.90	$371.20	$488.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.28 / $89.15 / $224.25	Professional		$50.28	$89.15	$224.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $169.16 / $169.16 / $331.11	Professional	50	$169.16	$169.16	$331.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $130.74 / $130.74 / $130.74	Professional		$130.74	$130.74	$130.74
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $81.73 / $81.73 / $81.73	Professional	50	$81.73	$81.73	$81.73
BCBS Facility/Professional Facility Modifier Low / Median / High Price $231.22 / $269.91 / $367.69	Facility		$231.22	$269.91	$367.69
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $133.16 / $191.53 / $236.36	Facility	50	$133.16	$191.53	$236.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $14.88 / $87.53 / $140.41	Professional		$14.88	$87.53	$140.41
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $135.02 / $135.02 / $373.08	Professional	50	$135.02	$135.02	$373.08
CareSource Facility/Professional Facility Modifier Low / Median / High Price $53.68 / $72.47 / $79.72	Facility		$53.68	$72.47	$79.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $146.49 / $174.39 / $185.00	Professional		$146.49	$174.39	$185.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.71 / $109.78 / $212.25	Professional		$56.71	$109.78	$212.25
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $97.63 / $226.97 / $2,056.00	Facility		$97.63	$226.97	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $231.00 / $371.20 / $967.20	Facility	50	$231.00	$371.20	$967.20
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $55.30 / $104.91 / $256.16	Professional		$55.30	$104.91	$256.16
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $169.16 / $169.16 / $331.11	Professional	50	$169.16	$169.16	$331.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $108.90 / $136.45 / $195.19	Professional		$108.90	$136.45	$195.19
United Facility/Professional Facility Modifier Low / Median / High Price $464.00 / $1,428.00 / $2,029.00	Facility		$464.00	$1,428.00	$2,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $106.44 / $139.60 / $236.18	Professional		$106.44	$139.60	$236.18