Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.17 / $982.69 / $1,873.02	Facility		$68.17	$982.69	$1,873.02
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $129.08 / $858.19 / $1,195.44	Facility	50	$129.08	$858.19	$1,195.44
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $13.13 / $13.63 / $28.80	Facility	53	$13.13	$13.63	$28.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.18 / $103.90 / $312.52	Professional		$48.18	$103.90	$312.52
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $75.88 / $143.31 / $329.02	Professional	50	$75.88	$143.31	$329.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.05 / $107.06 / $180.38	Professional		$48.05	$107.06	$180.38
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $143.72 / $143.72 / $143.72	Professional	50	$143.72	$143.72	$143.72
BCBS Facility/Professional Facility Modifier Low / Median / High Price $403.49 / $473.58 / $641.63	Facility		$403.49	$473.58	$641.63
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $255.02 / $297.08 / $418.40	Facility	50	$255.02	$297.08	$418.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.42 / $60.15 / $174.69	Professional		$13.42	$60.15	$174.69
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $160.84 / $160.84 / $349.38	Professional	50	$160.84	$160.84	$349.38
CareSource Facility/Professional Facility Modifier Low / Median / High Price $47.69 / $59.74 / $71.69	Facility		$47.69	$59.74	$71.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $99.21 / $130.27 / $200.11	Professional		$99.21	$130.27	$200.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.30 / $91.44 / $184.69	Professional		$44.30	$91.44	$184.69
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $68.17 / $678.28 / $2,056.00	Facility		$68.17	$678.28	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $129.08 / $858.19 / $1,195.44	Facility	50	$129.08	$858.19	$1,195.44
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $13.13 / $13.13 / $27.74	Facility	53	$13.13	$13.13	$27.74
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $55.49 / $108.04 / $189.64	Professional		$55.49	$108.04	$189.64
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $75.88 / $143.31 / $329.02	Professional	50	$75.88	$143.31	$329.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.79 / $101.78 / $144.21	Professional		$81.79	$101.78	$144.21
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 $99.49 / $136.77 / $199.26	Professional		$99.49	$136.77	$199.26