Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.53 / $129.87 / $286.85	Facility		$25.53	$129.87	$286.85
Aetna Facility/Professional Facility Modifier CQ Low / Median / High Price $44.40 / $74.27 / $147.41	Facility	CQ	$44.40	$74.27	$147.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.40 / $23.82 / $46.86	Professional		$14.40	$23.82	$46.86
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $39.27 / $85.50 / $1,719.53	Professional	CQ	$39.27	$85.50	$1,719.53
Ambetter Facility/Professional Professional Modifier CQ Low / Median / High Price $30.70 / $30.70 / $30.70	Professional	CQ	$30.70	$30.70	$30.70
BCBS Facility/Professional Facility Modifier Low / Median / High Price $35.34 / $49.88 / $64.65	Facility		$35.34	$49.88	$64.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.69 / $63.00 / $90.00	Professional		$31.69	$63.00	$90.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $15.00 / $27.00 / $45.98	Facility		$15.00	$27.00	$45.98
CareSource Facility/Professional Professional Modifier Low / Median / High Price $30.65 / $35.25 / $39.85	Professional		$30.65	$35.25	$39.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.50 / $65.00 / $65.00	Facility		$53.50	$65.00	$65.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.72 / $50.42 / $113.94	Professional		$24.72	$50.42	$113.94
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $25.53 / $119.99 / $313.18	Facility		$25.53	$119.99	$313.18
Health Alliance Plan Facility/Professional Facility Modifier CQ Low / Median / High Price $62.81 / $74.80 / $174.63	Facility	CQ	$62.81	$74.80	$174.63
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $20.14 / $26.81 / $45.50	Professional		$20.14	$26.81	$45.50
Health Alliance Plan Facility/Professional Professional Modifier CQ Low / Median / High Price $32.74 / $68.59 / $212.95	Professional	CQ	$32.74	$68.59	$212.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.57 / $33.05 / $45.42	Professional		$27.57	$33.05	$45.42
United Facility/Professional Professional Modifier Low / Median / High Price $26.95 / $30.68 / $36.09	Professional		$26.95	$30.68	$36.09