Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $301.85 / $718.32 / $4,933.00	Facility		$301.85	$718.32	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $3,487.54 / $5,089.32 / $5,089.32	Facility	50	$3,487.54	$5,089.32	$5,089.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $277.20 / $411.16 / $891.16	Professional		$277.20	$411.16	$891.16
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $681.48 / $681.48 / $1,676.07	Professional	50	$681.48	$681.48	$1,676.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $210.88 / $236.40 / $414.31	Professional		$210.88	$236.40	$414.31
BCBS Facility/Professional Facility Modifier Low / Median / High Price $873.35 / $1,017.92 / $1,379.12	Facility		$873.35	$1,017.92	$1,379.12
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $499.47 / $689.56 / $935.08	Facility	50	$499.47	$689.56	$935.08
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.02 / $239.50 / $378.17	Professional		$39.02	$239.50	$378.17
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $404.46 / $404.46 / $454.86	Professional	50	$404.46	$404.46	$454.86
CareSource Facility/Professional Facility Modifier Low / Median / High Price $197.26 / $247.70 / $269.39	Facility		$197.26	$247.70	$269.39
CareSource Facility/Professional Professional Modifier Low / Median / High Price $218.88 / $220.83 / $287.08	Professional		$218.88	$220.83	$287.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $225.13 / $451.37 / $581.34	Professional		$225.13	$451.37	$581.34
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $338.61 / $1,425.82 / $6,610.79	Facility		$338.61	$1,425.82	$6,610.79
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $3,487.54 / $3,487.54 / $5,089.32	Facility	50	$3,487.54	$3,487.54	$5,089.32
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $263.62 / $410.48 / $703.40	Professional		$263.62	$410.48	$703.40
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $681.48 / $1,676.07 / $1,676.07	Professional	50	$681.48	$1,676.07	$1,676.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $178.43 / $219.84 / $297.40	Professional		$178.43	$219.84	$297.40
United Facility/Professional Facility Modifier Low / Median / High Price $645.00 / $2,800.00 / $4,594.00	Facility		$645.00	$2,800.00	$4,594.00
United Facility/Professional Professional Modifier Low / Median / High Price $401.88 / $582.02 / $737.19	Professional		$401.88	$582.02	$737.19