Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.76 / $117.34 / $2,056.00	Facility		$67.76	$117.34	$2,056.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $543.19 / $1,005.90 / $1,958.00	Facility	50	$543.19	$1,005.90	$1,958.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.82 / $84.51 / $181.44	Professional		$48.82	$84.51	$181.44
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $74.17 / $141.66 / $580.14	Professional	50	$74.17	$141.66	$580.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.30 / $89.67 / $150.97	Professional		$80.30	$89.67	$150.97
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $69.56 / $129.85 / $192.18	Professional	50	$69.56	$129.85	$192.18
BCBS Facility/Professional Facility Modifier Low / Median / High Price $396.97 / $465.92 / $631.25	Facility		$396.97	$465.92	$631.25
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $250.89 / $315.63 / $411.01	Facility	50	$250.89	$315.63	$411.01
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.87 / $54.41 / $166.54	Professional		$12.87	$54.41	$166.54
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $161.91 / $246.28 / $289.74	Professional	50	$161.91	$246.28	$289.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $48.06 / $60.46 / $72.56	Facility		$48.06	$60.46	$72.56
CareSource Facility/Professional Professional Modifier Low / Median / High Price $82.23 / $109.04 / $168.57	Professional		$82.23	$109.04	$168.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.73 / $80.81 / $151.16	Professional		$44.73	$80.81	$151.16
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $67.76 / $186.73 / $2,056.00	Facility		$67.76	$186.73	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $186.74 / $979.00 / $1,958.00	Facility	50	$186.74	$979.00	$1,958.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $62.25 / $95.53 / $168.18	Professional		$62.25	$95.53	$168.18
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $74.17 / $145.90 / $580.14	Professional	50	$74.17	$145.90	$580.14
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 $87.00 / $106.24 / $143.96	Professional		$87.00	$106.24	$143.96