Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.98 / $280.41 / $4,933.00	Facility		$104.98	$280.41	$4,933.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.95 / $156.93 / $274.69	Professional		$87.95	$156.93	$274.69
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $267.48 / $267.48 / $523.29	Professional	50	$267.48	$267.48	$523.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $196.82 / $196.82 / $196.82	Professional		$196.82	$196.82	$196.82
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $295.23 / $295.23 / $295.23	Professional	50	$295.23	$295.23	$295.23
BCBS Facility/Professional Facility Modifier Low / Median / High Price $401.00 / $467.38 / $633.23	Facility		$401.00	$467.38	$633.23
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $214.88 / $293.19 / $429.34	Facility	50	$214.88	$293.19	$429.34
BCBS Facility/Professional Professional Modifier Low / Median / High Price $15.63 / $93.66 / $177.34	Professional		$15.63	$93.66	$177.34
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $140.49 / $161.56 / $373.59	Professional	50	$140.49	$161.56	$373.59
CareSource Facility/Professional Facility Modifier Low / Median / High Price $71.18 / $96.09 / $105.72	Facility		$71.18	$96.09	$105.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $185.37 / $185.37 / $220.68	Professional		$185.37	$185.37	$220.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.44 / $162.61 / $370.35	Professional		$79.44	$162.61	$370.35
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $132.27 / $336.49 / $4,933.00	Facility		$132.27	$336.49	$4,933.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $101.23 / $180.14 / $326.74	Professional		$101.23	$180.14	$326.74
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $267.48 / $279.00 / $523.29	Professional	50	$267.48	$279.00	$523.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $166.06 / $205.47 / $294.46	Professional		$166.06	$205.47	$294.46
United Facility/Professional Facility Modifier Low / Median / High Price $464.00 / $1,418.00 / $2,449.00	Facility		$464.00	$1,418.00	$2,449.00
United Facility/Professional Professional Modifier Low / Median / High Price $190.77 / $243.06 / $322.77	Professional		$190.77	$243.06	$322.77