Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $1,096.48 / $2,137.96	Facility		$91.20	$1,096.48	$2,137.96
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $831.76 / $3,890.45 / $3,890.45	Facility	50	$831.76	$3,890.45	$3,890.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $199.53 / $707.95	Professional		$63.10	$199.53	$707.95
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $147.91 / $239.88 / $575.44	Professional	50	$147.91	$239.88	$575.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $91.20 / $239.88	Professional		$52.48	$91.20	$239.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $95.50 / $346.74 / $549.54	Professional	50	$95.50	$346.74	$549.54
BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $199.53 / $199.53	Facility		$100.00	$199.53	$199.53
BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $199.53 / $398.11	Professional		$22.91	$199.53	$398.11
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $213.80 / $794.33 / $794.33	Professional	50	$213.80	$794.33	$794.33
CareSource Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $97.72 / $141.25	Facility		$75.86	$97.72	$141.25
CareSource Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $309.03 / $512.86	Professional		$223.87	$309.03	$512.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $173.78 / $371.54	Professional		$61.66	$173.78	$371.54
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $1,071.52 / $2,884.03	Facility		$112.20	$1,071.52	$2,884.03
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $416.87 / $2,630.27 / $3,890.45	Facility	50	$416.87	$2,630.27	$3,890.45
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $223.87 / $457.09	Professional		$67.61	$223.87	$457.09
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $147.91 / $275.42 / $645.65	Professional	50	$147.91	$275.42	$645.65
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $117.49 / $371.54	Professional		$54.95	$117.49	$371.54
United Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $1,258.93 / $2,041.74	Facility		$467.74	$1,258.93	$2,041.74
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $162.18 / $281.84	Professional		$70.79	$162.18	$281.84