Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $118.75 / $376.92 / $2,935.76	Facility		$118.75	$376.92	$2,935.76
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,312.52 / $2,515.15 / $3,635.23	Facility	50	$1,312.52	$2,515.15	$3,635.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.89 / $159.12 / $305.24	Professional		$86.89	$159.12	$305.24
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $135.16 / $280.68 / $1,047.38	Professional	50	$135.16	$280.68	$1,047.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $155.72 / $174.30 / $174.30	Professional		$155.72	$174.30	$174.30
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $137.54 / $233.57 / $438.75	Professional	50	$137.54	$233.57	$438.75
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,317.34 / $1,546.17 / $2,094.82	Facility		$1,317.34	$1,546.17	$2,094.82
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $888.54 / $1,136.27 / $1,363.96	Facility	50	$888.54	$1,136.27	$1,363.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.71 / $142.75 / $275.29	Professional		$25.71	$142.75	$275.29
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $218.10 / $361.26 / $425.01	Professional	50	$218.10	$361.26	$425.01
CareSource Facility/Professional Facility Modifier Low / Median / High Price $85.34 / $106.81 / $128.01	Facility		$85.34	$106.81	$128.01
CareSource Facility/Professional Professional Modifier Low / Median / High Price $160.22 / $211.25 / $324.57	Professional		$160.22	$211.25	$324.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.66 / $152.07 / $289.77	Professional		$80.66	$152.07	$289.77
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $118.75 / $1,114.56 / $3,792.20	Facility		$118.75	$1,114.56	$3,792.20
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $787.10 / $2,438.11 / $4,014.31	Facility	50	$787.10	$2,438.11	$4,014.31
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $98.24 / $177.62 / $301.39	Professional		$98.24	$177.62	$301.39
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $135.16 / $293.08 / $1,023.11	Professional	50	$135.16	$293.08	$1,023.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $163.59 / $203.56 / $288.42	Professional		$163.59	$203.56	$288.42
United Facility/Professional Facility Modifier Low / Median / High Price $645.00 / $3,005.00 / $4,504.00	Facility		$645.00	$3,005.00	$4,504.00
United Facility/Professional Professional Modifier Low / Median / High Price $171.52 / $213.50 / $308.74	Professional		$171.52	$213.50	$308.74