Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.04 / $106.40 / $144.01	Facility		$38.04	$106.40	$144.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.50 / $94.50 / $166.00	Professional		$74.50	$94.50	$166.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $117.65 / $117.65 / $117.65	Professional	25	$117.65	$117.65	$117.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.86 / $78.92 / $124.40	Professional		$56.86	$78.92	$124.40
BCBS Facility/Professional Facility Modifier Low / Median / High Price $93.17 / $110.35 / $133.93	Facility		$93.17	$110.35	$133.93
BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.99 / $116.46 / $148.97	Professional		$98.99	$116.46	$148.97
CareSource Facility/Professional Facility Modifier Low / Median / High Price $66.95 / $90.05 / $126.07	Facility		$66.95	$90.05	$126.07
CareSource Facility/Professional Professional Modifier Low / Median / High Price $101.48 / $121.81 / $235.28	Professional		$101.48	$121.81	$235.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $79.00 / $132.93	Professional		$60.00	$79.00	$132.93
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $31.49 / $106.40 / $157.16	Facility		$31.49	$106.40	$157.16
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $75.76 / $96.94 / $136.06	Professional		$75.76	$96.94	$136.06
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $117.65 / $117.65 / $117.65	Professional	25	$117.65	$117.65	$117.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.08 / $100.56 / $145.15	Professional		$81.08	$100.56	$145.15
United Facility/Professional Professional Modifier Low / Median / High Price $74.98 / $99.10 / $139.38	Professional		$74.98	$99.10	$139.38