Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $169.23 / $623.36 / $4,933.00	Facility		$169.23	$623.36	$4,933.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.75 / $142.86 / $248.00	Professional		$100.75	$142.86	$248.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.44 / $113.44 / $213.40	Professional		$113.44	$113.44	$213.40
BCBS Facility/Professional Facility Modifier Low / Median / High Price $286.64 / $334.61 / $455.83	Facility		$286.64	$334.61	$455.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.69 / $83.47 / $147.66	Professional		$19.69	$83.47	$147.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $103.43 / $139.63 / $153.61	Facility		$103.43	$139.63	$153.61
CareSource Facility/Professional Professional Modifier Low / Median / High Price $152.41 / $181.45 / $197.37	Professional		$152.41	$181.45	$197.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.21 / $160.22 / $251.07	Professional		$111.21	$160.22	$251.07
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $147.72 / $623.36 / $4,933.00	Facility		$147.72	$623.36	$4,933.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $127.40 / $164.76 / $259.97	Professional		$127.40	$164.76	$259.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $137.22 / $170.59 / $244.30	Professional		$137.22	$170.59	$244.30
United Facility/Professional Facility Modifier Low / Median / High Price $464.00 / $1,247.00 / $1,844.00	Facility		$464.00	$1,247.00	$1,844.00
United Facility/Professional Professional Modifier Low / Median / High Price $160.68 / $192.29 / $252.31	Professional		$160.68	$192.29	$252.31