Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $27.80 / $123.95 / $285.08	Facility		$27.80	$123.95	$285.08
Aetna Facility/Professional Facility Modifier CO Low / Median / High Price $48.62 / $67.28 / $136.16	Facility	CO	$48.62	$67.28	$136.16
Aetna Facility/Professional Facility Modifier CQ Low / Median / High Price $65.45 / $111.94 / $392.06	Facility	CQ	$65.45	$111.94	$392.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.40 / $25.98 / $55.80	Professional		$14.40	$25.98	$55.80
Aetna Facility/Professional Professional Modifier CO Low / Median / High Price $54.47 / $54.47 / $54.47	Professional	CO	$54.47	$54.47	$54.47
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $27.07 / $58.67 / $302.83	Professional	CQ	$27.07	$58.67	$302.83
Ambetter Facility/Professional Professional Modifier CQ Low / Median / High Price $32.86 / $32.86 / $32.86	Professional	CQ	$32.86	$32.86	$32.86
BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.20 / $53.91 / $69.02	Facility		$38.20	$53.91	$69.02
BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $63.00 / $90.00	Professional		$34.67	$63.00	$90.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $15.00 / $27.91 / $49.32	Facility		$15.00	$27.91	$49.32
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.88 / $37.81 / $42.69	Professional		$32.88	$37.81	$42.69
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 $25.87 / $54.94 / $113.94	Professional		$25.87	$54.94	$113.94
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $27.80 / $123.95 / $334.26	Facility		$27.80	$123.95	$334.26
Health Alliance Plan Facility/Professional Facility Modifier CO Low / Median / High Price $45.30 / $67.28 / $136.16	Facility	CO	$45.30	$67.28	$136.16
Health Alliance Plan Facility/Professional Facility Modifier CQ Low / Median / High Price $65.45 / $107.98 / $404.37	Facility	CQ	$65.45	$107.98	$404.37
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $21.51 / $28.44 / $55.58	Professional		$21.51	$28.44	$55.58
Health Alliance Plan Facility/Professional Professional Modifier CO Low / Median / High Price $54.47 / $54.47 / $54.47	Professional	CO	$54.47	$54.47	$54.47
Health Alliance Plan Facility/Professional Professional Modifier CQ Low / Median / High Price $30.58 / $56.53 / $152.00	Professional	CQ	$30.58	$56.53	$152.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $33.09 / $46.32	Professional		$26.31	$33.09	$46.32
United Facility/Professional Professional Modifier Low / Median / High Price $27.46 / $33.15 / $38.40	Professional		$27.46	$33.15	$38.40