Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $155.46 / $464.00 / $4,933.00	Facility		$155.46	$464.00	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $304.89 / $842.64 / $2,574.94	Facility	50	$304.89	$842.64	$2,574.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.75 / $157.71 / $267.58	Professional		$124.75	$157.71	$267.58
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $217.52 / $646.23 / $993.59	Professional	50	$217.52	$646.23	$993.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.60 / $112.60 / $140.00	Professional		$112.60	$112.60	$140.00
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $168.90 / $183.69 / $250.00	Professional	50	$168.90	$183.69	$250.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $392.68 / $460.89 / $624.42	Facility		$392.68	$460.89	$624.42
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $213.04 / $325.74 / $423.38	Facility	50	$213.04	$325.74	$423.38
BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.03 / $148.44 / $226.90	Professional		$24.03	$148.44	$226.90
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $192.78 / $226.80 / $261.45	Professional	50	$192.78	$226.80	$261.45
CareSource Facility/Professional Facility Modifier Low / Median / High Price $111.09 / $139.11 / $166.64	Facility		$111.09	$139.11	$166.64
CareSource Facility/Professional Professional Modifier Low / Median / High Price $123.67 / $167.45 / $260.45	Professional		$123.67	$167.45	$260.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.24 / $156.68 / $267.27	Professional		$99.24	$156.68	$267.27
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $184.30 / $580.90 / $4,933.00	Facility		$184.30	$580.90	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $842.63 / $842.64 / $2,574.94	Facility	50	$842.63	$842.64	$2,574.94
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $133.69 / $178.39 / $348.13	Professional		$133.69	$178.39	$348.13
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $236.70 / $743.04 / $1,770.22	Professional	50	$236.70	$743.04	$1,770.22
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 $137.47 / $172.33 / $224.18	Professional		$137.47	$172.33	$224.18