Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $78.56 / $454.96 / $2,056.00	Facility		$78.56	$454.96	$2,056.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $537.54 / $1,105.00 / $2,467.05	Facility	50	$537.54	$1,105.00	$2,467.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.08 / $93.12 / $171.01	Professional		$57.08	$93.12	$171.01
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $86.85 / $254.64 / $560.02	Professional	50	$86.85	$254.64	$560.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.01 / $87.01 / $87.01	Professional		$87.01	$87.01	$87.01
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $90.74 / $130.51 / $145.74	Professional	50	$90.74	$130.51	$145.74
BCBS Facility/Professional Facility Modifier Low / Median / High Price $431.14 / $506.03 / $685.59	Facility		$431.14	$506.03	$685.59
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $233.91 / $342.79 / $447.06	Facility	50	$233.91	$342.79	$447.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.76 / $88.64 / $197.18	Professional		$16.76	$88.64	$197.18
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $189.60 / $189.60 / $312.10	Professional	50	$189.60	$189.60	$312.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $56.30 / $70.98 / $85.19	Facility		$56.30	$70.98	$85.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $88.47 / $118.01 / $183.03	Professional		$88.47	$118.01	$183.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $89.09 / $167.90	Professional		$52.48	$89.09	$167.90
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $78.56 / $540.10 / $2,056.00	Facility		$78.56	$540.10	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $544.79 / $1,717.88 / $2,386.69	Facility	50	$544.79	$1,717.88	$2,386.69
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $63.29 / $97.94 / $168.27	Professional		$63.29	$97.94	$168.27
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $89.90 / $266.13 / $560.02	Professional	50	$89.90	$266.13	$560.02
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 $94.23 / $117.79 / $156.09	Professional		$94.23	$117.79	$156.09