Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $88.37 / $751.22 / $2,056.00	Facility		$88.37	$751.22	$2,056.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $416.16 / $3,188.00 / $3,901.72	Facility	50	$416.16	$3,188.00	$3,901.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.97 / $191.53 / $417.61	Professional		$62.97	$191.53	$417.61
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $97.94 / $289.02 / $574.54	Professional	50	$97.94	$289.02	$574.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.59 / $67.59 / $67.59	Professional		$67.59	$67.59	$67.59
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $101.39 / $101.39 / $101.39	Professional	50	$101.39	$101.39	$101.39
BCBS Facility/Professional Facility Modifier Low / Median / High Price $865.54 / $1,015.89 / $1,376.37	Facility		$865.54	$1,015.89	$1,376.37
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $547.04 / $716.94 / $933.22	Facility	50	$547.04	$716.94	$933.22
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.07 / $106.52 / $239.03	Professional		$16.07	$106.52	$239.03
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $213.04 / $213.04 / $794.64	Professional	50	$213.04	$213.04	$794.64
CareSource Facility/Professional Facility Modifier Low / Median / High Price $63.25 / $79.55 / $95.46	Facility		$63.25	$79.55	$95.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $223.98 / $292.14 / $444.71	Professional		$223.98	$292.14	$444.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.84 / $175.25 / $338.70	Professional		$58.84	$175.25	$338.70
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $88.37 / $751.22 / $2,056.00	Facility		$88.37	$751.22	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $769.22 / $3,188.00 / $3,901.72	Facility	50	$769.22	$3,188.00	$3,901.72
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $73.64 / $202.07 / $410.94	Professional		$73.64	$202.07	$410.94
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $99.32 / $289.02 / $641.63	Professional	50	$99.32	$289.02	$641.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $189.87 / $237.32 / $339.00	Professional		$189.87	$237.32	$339.00
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 $191.32 / $246.33 / $308.89	Professional		$191.32	$246.33	$308.89