Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.59 / $117.34 / $4,933.00	Facility		$68.59	$117.34	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $582.16 / $582.16 / $582.16	Facility	50	$582.16	$582.16	$582.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.57 / $79.47 / $146.50	Professional		$47.57	$79.47	$146.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $73.88 / $129.26 / $236.96	Professional	50	$73.88	$129.26	$236.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.14 / $79.14 / $79.14	Professional		$79.14	$79.14	$79.14
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $118.71 / $118.71 / $118.71	Professional	50	$118.71	$118.71	$118.71
BCBS Facility/Professional Facility Modifier Low / Median / High Price $398.58 / $467.82 / $633.82	Facility		$398.58	$467.82	$633.82
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $216.25 / $316.91 / $413.31	Facility	50	$216.25	$316.91	$413.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.95 / $76.19 / $175.25	Professional		$12.95	$76.19	$175.25
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $162.97 / $162.97 / $286.54	Professional	50	$162.97	$162.97	$286.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $48.28 / $60.43 / $72.51	Facility		$48.28	$60.43	$72.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $81.62 / $107.67 / $166.22	Professional		$81.62	$107.67	$166.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.90 / $82.02 / $151.16	Professional		$44.90	$82.02	$151.16
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $68.59 / $117.34 / $4,933.00	Facility		$68.59	$117.34	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $582.16 / $582.16 / $970.53	Facility	50	$582.16	$582.16	$970.53
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $54.60 / $89.06 / $148.84	Professional		$54.60	$89.06	$148.84
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $73.88 / $77.56 / $236.96	Professional	50	$73.88	$77.56	$236.96
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 $86.66 / $105.40 / $139.13	Professional		$86.66	$105.40	$139.13