Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $691.83 / $2,041.74	Facility		$83.18	$691.83	$2,041.74
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $537.03 / $1,202.26 / $2,344.23	Facility	50	$537.03	$1,202.26	$2,344.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $97.72 / $323.59	Professional		$57.54	$97.72	$323.59
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $91.20 / $194.98 / $562.34	Professional	50	$91.20	$194.98	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $89.13 / $104.71	Professional		$47.86	$89.13	$104.71
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $131.83 / $158.49	Professional	50	$83.18	$131.83	$158.49
BCBS Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $177.83	Facility		$89.13	$89.13	$177.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $154.88 / $177.83	Professional		$54.95	$154.88	$177.83
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $190.55 / $309.03 / $309.03	Professional	50	$190.55	$309.03	$309.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $87.10 / $125.89	Facility		$67.61	$87.10	$125.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $123.03 / $213.80	Professional		$91.20	$123.03	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $93.33 / $165.96	Professional		$54.95	$93.33	$165.96
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $549.54 / $2,041.74	Facility		$83.18	$549.54	$2,041.74
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $537.03 / $870.96 / $2,344.23	Facility	50	$537.03	$870.96	$2,344.23
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $107.15 / $213.80	Professional		$61.66	$107.15	$213.80
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $89.13 / $245.47 / $562.34	Professional	50	$89.13	$245.47	$562.34
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $89.13 / $151.36	Professional		$51.29	$89.13	$151.36
United Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $1,258.93 / $2,041.74	Facility		$467.74	$1,258.93	$2,041.74
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $91.20 / $141.25	Professional		$63.10	$91.20	$141.25