Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $251.25 / $1,761.44 / $4,933.00	Facility		$251.25	$1,761.44	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,918.18 / $6,079.81 / $7,508.59	Facility	50	$1,918.18	$6,079.81	$7,508.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $207.72 / $395.24 / $650.07	Professional		$207.72	$395.24	$650.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $280.01 / $589.01 / $1,236.43	Professional	50	$280.01	$589.01	$1,236.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $192.96 / $192.96 / $192.96	Professional		$192.96	$192.96	$192.96
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $289.44 / $289.44 / $289.44	Professional	50	$289.44	$289.44	$289.44
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,774.19 / $2,082.38 / $2,821.29	Facility		$1,774.19	$2,082.38	$2,821.29
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $1,121.33 / $1,450.89 / $1,763.31	Facility	50	$1,121.33	$1,450.89	$1,763.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.84 / $355.58 / $495.66	Professional		$48.84	$355.58	$495.66
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $460.97 / $460.97 / $1,029.78	Professional	50	$460.97	$460.97	$1,029.78
CareSource Facility/Professional Facility Modifier Low / Median / High Price $180.27 / $225.96 / $270.41	Facility		$180.27	$225.96	$270.41
CareSource Facility/Professional Professional Modifier Low / Median / High Price $388.56 / $509.52 / $780.33	Professional		$388.56	$509.52	$780.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.05 / $359.10 / $725.57	Professional		$170.05	$359.10	$725.57
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $251.25 / $2,056.00 / $5,570.37	Facility		$251.25	$2,056.00	$5,570.37
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $1,918.18 / $6,079.81 / $7,508.59	Facility	50	$1,918.18	$6,079.81	$7,508.59
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $234.34 / $443.23 / $666.02	Professional		$234.34	$443.23	$666.02
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $321.29 / $889.02 / $1,440.00	Professional	50	$321.29	$889.02	$1,440.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.13 / $343.06 / $507.96	Professional		$32.13	$343.06	$507.96
United Facility/Professional Facility Modifier Low / Median / High Price $1,450.00 / $5,806.00 / $8,339.00	Facility		$1,450.00	$5,806.00	$8,339.00
United Facility/Professional Professional Modifier Low / Median / High Price $407.18 / $526.52 / $666.07	Professional		$407.18	$526.52	$666.07