Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $156.12 / $245.18 / $4,933.00	Facility		$156.12	$245.18	$4,933.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $286.57 / $295.20 / $1,140.05	Facility	50	$286.57	$295.20	$1,140.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.78 / $150.54 / $246.72	Professional		$103.78	$150.54	$246.72
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $58.32 / $198.02 / $247.22	Professional	50	$58.32	$198.02	$247.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.70 / $129.51 / $248.49	Professional		$55.70	$129.51	$248.49
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $194.26 / $208.89 / $372.73	Professional	50	$194.26	$208.89	$372.73
BCBS Facility/Professional Facility Modifier Low / Median / High Price $294.77 / $343.57 / $465.48	Facility		$294.77	$343.57	$465.48
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $197.44 / $242.83 / $315.61	Facility	50	$197.44	$242.83	$315.61
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.92 / $143.90 / $215.86	Professional		$25.92	$143.90	$215.86
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $219.87 / $219.87 / $270.27	Professional	50	$219.87	$219.87	$270.27
CareSource Facility/Professional Facility Modifier Low / Median / High Price $107.18 / $134.36 / $146.58	Facility		$107.18	$134.36	$146.58
CareSource Facility/Professional Professional Modifier Low / Median / High Price $130.51 / $130.75 / $169.98	Professional		$130.51	$130.75	$169.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.48 / $133.62 / $222.39	Professional		$96.48	$133.62	$222.39
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $146.26 / $570.02 / $4,933.00	Facility		$146.26	$570.02	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $286.57 / $295.20 / $1,140.05	Facility	50	$286.57	$295.20	$1,140.05
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $120.54 / $156.12 / $246.72	Professional		$120.54	$156.12	$246.72
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $58.32 / $198.02 / $246.75	Professional	50	$58.32	$198.02	$246.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $89.29 / $119.07 / $167.33	Professional		$89.29	$119.07	$167.33
United Facility/Professional Facility Modifier Low / Median / High Price $300.00 / $1,386.00 / $2,449.00	Facility		$300.00	$1,386.00	$2,449.00
United Facility/Professional Professional Modifier Low / Median / High Price $145.65 / $169.80 / $234.20	Professional		$145.65	$169.80	$234.20