Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $20.55 / $75.47 / $394.42	Facility		$20.55	$75.47	$394.42
Aetna Facility/Professional Facility Modifier CQ Low / Median / High Price $25.76 / $61.60 / $119.67	Facility	CQ	$25.76	$61.60	$119.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.00 / $20.56 / $47.02	Professional		$13.00	$20.56	$47.02
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $17.87 / $18.55 / $62.37	Professional	CQ	$17.87	$18.55	$62.37
Ambetter Facility/Professional Professional Modifier CQ Low / Median / High Price $19.63 / $19.63 / $19.63	Professional	CQ	$19.63	$19.63	$19.63
BCBS Facility/Professional Facility Modifier Low / Median / High Price $29.99 / $42.32 / $54.87	Facility		$29.99	$42.32	$54.87
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.54 / $63.00 / $90.00	Professional		$25.54	$63.00	$90.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $15.00 / $26.00 / $39.00	Facility		$15.00	$26.00	$39.00
CareSource Facility/Professional Professional Modifier Low / Median / High Price $26.00 / $29.90 / $33.84	Professional		$26.00	$29.90	$33.84
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 $21.99 / $42.98 / $111.17	Professional		$21.99	$42.98	$111.17
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $20.55 / $76.81 / $438.25	Facility		$20.55	$76.81	$438.25
Health Alliance Plan Facility/Professional Facility Modifier CQ Low / Median / High Price $37.52 / $73.89 / $121.84	Facility	CQ	$37.52	$73.89	$121.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $23.12 / $42.47	Professional		$17.78	$23.12	$42.47
Health Alliance Plan Facility/Professional Professional Modifier CQ Low / Median / High Price $17.87 / $40.68 / $135.93	Professional	CQ	$17.87	$40.68	$135.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.89 / $17.89 / $75.00	Professional		$17.89	$17.89	$75.00
United Facility/Professional Professional Modifier Low / Median / High Price $23.47 / $25.99 / $30.58	Professional		$23.47	$25.99	$30.58