Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $125.89 / $323.59	Facility		$27.54	$125.89	$323.59
Aetna Facility/Professional Facility Modifier CO Low / Median / High Price $45.71 / $69.18 / $2,041.74	Facility	CO	$45.71	$69.18	$2,041.74
Aetna Facility/Professional Facility Modifier CQ Low / Median / High Price $64.57 / $107.15 / $467.74	Facility	CQ	$64.57	$107.15	$467.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $31.62 / $100.00	Professional		$19.05	$31.62	$100.00
Aetna Facility/Professional Professional Modifier CO Low / Median / High Price $54.95 / $54.95 / $104.71	Professional	CO	$54.95	$54.95	$104.71
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $30.90 / $46.77 / $151.36	Professional	CQ	$30.90	$46.77	$151.36
Ambetter Facility/Professional Professional Modifier CO Low / Median / High Price $20.89 / $26.92 / $27.54	Professional	CO	$20.89	$26.92	$27.54
Ambetter Facility/Professional Professional Modifier CQ Low / Median / High Price $19.05 / $22.39 / $26.92	Professional	CQ	$19.05	$22.39	$26.92
BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $54.95 / $70.79	Facility		$38.02	$54.95	$70.79
BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $36.31 / $36.31	Professional		$34.67	$36.31	$36.31
CareSource Facility/Professional Facility Modifier Low / Median / High Price $15.14 / $19.95 / $40.74	Facility		$15.14	$19.95	$40.74
CareSource Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $38.90	Professional		$33.88	$33.88	$38.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $64.57	Facility		$53.70	$53.70	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $36.31 / $81.28	Professional		$25.12	$36.31	$81.28
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $123.03 / $288.40	Facility		$27.54	$123.03	$288.40
Health Alliance Plan Facility/Professional Facility Modifier CO Low / Median / High Price $45.71 / $67.61 / $2,041.74	Facility	CO	$45.71	$67.61	$2,041.74
Health Alliance Plan Facility/Professional Facility Modifier CQ Low / Median / High Price $64.57 / $107.15 / $467.74	Facility	CQ	$64.57	$107.15	$467.74
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $32.36 / $70.79	Professional		$21.88	$32.36	$70.79
Health Alliance Plan Facility/Professional Professional Modifier CO Low / Median / High Price $31.62 / $31.62 / $54.95	Professional	CO	$31.62	$31.62	$54.95
Health Alliance Plan Facility/Professional Professional Modifier CQ Low / Median / High Price $30.90 / $38.02 / $151.36	Professional	CQ	$30.90	$38.02	$151.36
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Facility		$64.57	$64.57	$64.57
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $32.36 / $56.23	Professional		$22.91	$32.36	$56.23
United Facility/Professional Facility Modifier Low / Median / High Price $28.18 / $34.67 / $38.90	Facility		$28.18	$34.67	$38.90
United Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $38.90	Professional		$28.18	$33.11	$38.90