Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $18.53 / $121.76 / $2,056.00	Facility		$18.53	$121.76	$2,056.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.46 / $17.21 / $35.64	Professional		$11.46	$17.21	$35.64
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.75 / $34.86 / $55.58	Professional	50	$18.75	$34.86	$55.58
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $6.31 / $8.56 / $9.27	Professional	52	$6.31	$8.56	$9.27
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $2.52 / $3.42 / $3.71	Professional	53	$2.52	$3.42	$3.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $6.97 / $15.23 / $19.80	Professional		$6.97	$15.23	$19.80
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $18.05 / $22.85 / $22.85	Professional	50	$18.05	$22.85	$22.85
BCBS Facility/Professional Facility Modifier Low / Median / High Price $90.93 / $125.69 / $290.37	Facility		$90.93	$125.69	$290.37
BCBS Facility/Professional Professional Modifier Low / Median / High Price $5.38 / $25.03 / $36.86	Professional		$5.38	$25.03	$36.86
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $31.92 / $37.54 / $37.54	Professional	50	$31.92	$37.54	$37.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $13.89 / $18.68 / $20.63	Facility		$13.89	$18.68	$20.63
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.57 / $17.35 / $18.11	Professional		$14.57	$17.35	$18.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $11.15 / $17.22 / $30.12	Professional		$11.15	$17.22	$30.12
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $23.34 / $123.99 / $2,056.00	Facility		$23.34	$123.99	$2,056.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $12.17 / $17.98 / $34.97	Professional		$12.17	$17.98	$34.97
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $19.38 / $35.02 / $55.58	Professional	50	$19.38	$35.02	$55.58
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $7.15 / $9.27 / $12.78	Professional	52	$7.15	$9.27	$12.78
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $2.73 / $3.42 / $4.40	Professional	53	$2.73	$3.42	$4.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Professional		$30.00	$30.00	$30.00
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 $14.05 / $16.37 / $24.45	Professional		$14.05	$16.37	$24.45