Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $372.85 / $2,740.00 / $6,135.48	Facility		$372.85	$2,740.00	$6,135.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $256.42 / $637.89 / $1,107.56	Professional		$256.42	$637.89	$1,107.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $262.38 / $341.09 / $354.21	Professional		$262.38	$341.09	$354.21
BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,863.90 / $3,337.97 / $4,522.42	Facility		$2,863.90	$3,337.97	$4,522.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.62 / $409.04 / $774.47	Professional		$67.62	$409.04	$774.47
CareSource Facility/Professional Facility Modifier Low / Median / High Price $242.01 / $326.70 / $359.44	Facility		$242.01	$326.70	$359.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $741.21 / $741.21 / $882.39	Professional		$741.21	$741.21	$882.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $274.89 / $528.15 / $1,490.53	Professional		$274.89	$528.15	$1,490.53
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $609.99 / $2,740.00 / $6,135.48	Facility		$609.99	$2,740.00	$6,135.48
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $298.10 / $791.84 / $1,281.58	Professional		$298.10	$791.84	$1,281.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.82 / $693.73 / $1,035.58	Professional		$64.82	$693.73	$1,035.58
United Facility/Professional Facility Modifier Low / Median / High Price $3,296.00 / $7,780.00 / $10,556.00	Facility		$3,296.00	$7,780.00	$10,556.00
United Facility/Professional Professional Modifier Low / Median / High Price $865.07 / $1,067.28 / $1,495.65	Professional		$865.07	$1,067.28	$1,495.65