Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $145.53 / $264.61 / $4,933.00	Facility		$145.53	$264.61	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $455.34 / $647.24 / $647.24	Facility	50	$455.34	$647.24	$647.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.80 / $129.78 / $244.49	Professional		$95.80	$129.78	$244.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $84.33 / $250.00 / $713.79	Professional	50	$84.33	$250.00	$713.79
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $160.41 / $160.41 / $160.41	Professional	50	$160.41	$160.41	$160.41
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 $31.50 / $177.36 / $268.64	Professional		$31.50	$177.36	$268.64
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $226.13 / $266.04 / $334.74	Professional	50	$226.13	$266.04	$334.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $104.58 / $134.50 / $161.40	Facility		$104.58	$134.50	$161.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $125.55 / $171.96 / $271.05	Professional		$125.55	$171.96	$271.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $143.69 / $258.17	Professional		$100.00	$143.69	$258.17
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $126.43 / $264.61 / $4,933.00	Facility		$126.43	$264.61	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $455.34 / $647.24 / $1,734.23	Facility	50	$455.34	$647.24	$1,734.23
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $108.35 / $146.79 / $258.29	Professional		$108.35	$146.79	$258.29
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $84.33 / $309.20 / $713.79	Professional	50	$84.33	$309.20	$713.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $89.22 / $140.02 / $219.25	Professional		$89.22	$140.02	$219.25
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 $125.52 / $158.31 / $208.13	Professional		$125.52	$158.31	$208.13