Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.89 / $121.88 / $354.93	Facility		$47.89	$121.88	$354.93
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $74.52 / $366.44 / $8,940.20	Facility	50	$74.52	$366.44	$8,940.20
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $19.34 / $20.95 / $29.98	Facility	52	$19.34	$20.95	$29.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.28 / $51.47 / $124.82	Professional		$29.28	$51.47	$124.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.65 / $83.21 / $171.46	Professional	50	$35.65	$83.21	$171.46
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.55 / $20.95 / $29.98	Professional	52	$14.55	$20.95	$29.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.96 / $32.61 / $67.17	Professional		$23.96	$32.61	$67.17
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $66.84 / $71.88 / $89.85	Professional	50	$66.84	$71.88	$89.85
BCBS Facility/Professional Facility Modifier Low / Median / High Price $138.81 / $162.03 / $220.73	Facility		$138.81	$162.03	$220.73
BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $79.94 / $114.97 / $149.66	Facility	50	$79.94	$114.97	$149.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $6.74 / $37.70 / $60.48	Professional		$6.74	$37.70	$60.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $30.32 / $42.45 / $75.22	Facility		$30.32	$42.45	$75.22
CareSource Facility/Professional Professional Modifier Low / Median / High Price $45.68 / $54.38 / $58.21	Professional		$45.68	$54.38	$58.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.13 / $49.38 / $74.37	Professional		$32.13	$49.38	$74.37
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $52.79 / $120.07 / $354.93	Facility		$52.79	$120.07	$354.93
Health Alliance Plan Facility/Professional Facility Modifier 50 Low / Median / High Price $102.14 / $366.44 / $8,940.20	Facility	50	$102.14	$366.44	$8,940.20
Health Alliance Plan Facility/Professional Facility Modifier 52 Low / Median / High Price $19.34 / $19.34 / $27.68	Facility	52	$19.34	$19.34	$27.68
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $38.67 / $52.28 / $90.63	Professional		$38.67	$52.28	$90.63
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $29.04 / $83.21 / $143.96	Professional	50	$29.04	$83.21	$143.96
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $18.02 / $24.85 / $41.54	Professional	52	$18.02	$24.85	$41.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.90 / $68.34 / $97.88	Professional		$54.90	$68.34	$97.88
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 $51.41 / $59.27 / $88.29	Professional		$51.41	$59.27	$88.29