Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $146.31 / $597.53 / $2,056.00	Facility		$146.31	$597.53	$2,056.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $648.09 / $664.82 / $1,482.62	Facility	50	$648.09	$664.82	$1,482.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.76 / $118.80 / $267.38	Professional		$85.76	$118.80	$267.38
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $131.12 / $177.95 / $659.34	Professional	50	$131.12	$177.95	$659.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.44 / $111.11 / $192.50	Professional		$102.44	$111.11	$192.50
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $92.16 / $156.71 / $288.74	Professional	50	$92.16	$156.71	$288.74
BCBS Facility/Professional Facility Modifier Low / Median / High Price $483.75 / $563.83 / $763.90	Facility		$483.75	$563.83	$763.90
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $259.20 / $353.70 / $498.13	Facility	50	$259.20	$353.70	$498.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.20 / $85.28 / $204.67	Professional		$23.20	$85.28	$204.67
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $218.90 / $218.90 / $269.24	Professional	50	$218.90	$218.90	$269.24
CareSource Facility/Professional Facility Modifier Low / Median / High Price $85.36 / $107.38 / $117.04	Facility		$85.36	$107.38	$117.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $102.44 / $103.93 / $135.11	Professional		$102.44	$103.93	$135.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.26 / $118.97 / $243.30	Professional		$78.26	$118.97	$243.30
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $116.31 / $597.53 / $2,056.00	Facility		$116.31	$597.53	$2,056.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $620.42 / $664.82 / $1,482.62	Facility	50	$620.42	$664.82	$1,482.62
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $90.54 / $123.20 / $241.94	Professional		$90.54	$123.20	$241.94
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $131.12 / $177.14 / $659.34	Professional	50	$131.12	$177.14	$659.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $82.37 / $101.38 / $139.66	Professional		$82.37	$101.38	$139.66
United Facility/Professional Facility Modifier Low / Median / High Price $259.98 / $1,247.00 / $2,029.00	Facility		$259.98	$1,247.00	$2,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $110.12 / $137.97 / $258.32	Professional		$110.12	$137.97	$258.32