Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $60.40 / $100.54 / $305.02	Facility		$60.40	$100.54	$305.02
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $240.07 / $3,522.88 / $3,522.88	Facility	50	$240.07	$3,522.88	$3,522.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.22 / $92.80 / $200.30	Professional		$48.22	$92.80	$200.30
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $183.75 / $330.58 / $330.58	Professional	50	$183.75	$330.58	$330.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.81 / $54.35 / $85.48	Professional		$41.81	$54.35	$85.48
BCBS Facility/Professional Facility Modifier Low / Median / High Price $150.16 / $175.28 / $238.78	Facility		$150.16	$175.28	$238.78
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $86.48 / $119.39 / $161.90	Facility	50	$86.48	$119.39	$161.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.19 / $74.58 / $119.64	Professional		$12.19	$74.58	$119.64
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $115.04 / $164.34 / $193.34	Professional	50	$115.04	$164.34	$193.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $45.12 / $60.91 / $67.02	Facility		$45.12	$60.91	$67.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $76.04 / $90.53 / $96.92	Professional		$76.04	$90.53	$96.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.09 / $73.88 / $127.20	Professional		$48.09	$73.88	$127.20
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $68.20 / $126.68 / $308.04	Facility		$68.20	$126.68	$308.04
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $240.07 / $308.89 / $3,522.88	Facility	50	$240.07	$308.89	$3,522.88
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $55.76 / $105.57 / $173.93	Professional		$55.76	$105.57	$173.93
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $183.75 / $183.75 / $330.58	Professional	50	$183.75	$183.75	$330.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.79 / $102.47 / $146.41	Professional		$81.79	$102.47	$146.41
United Facility/Professional Facility Modifier Low / Median / High Price $464.00 / $1,428.00 / $2,029.00	Facility		$464.00	$1,428.00	$2,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $94.65 / $132.07 / $160.46	Professional		$94.65	$132.07	$160.46