Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.75 / $118.76 / $126.26	Facility		$87.75	$118.76	$126.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.56 / $124.93 / $205.60	Professional		$79.56	$124.93	$205.60
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $224.20 / $224.20 / $257.00	Professional	25	$224.20	$224.20	$257.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.48 / $142.91 / $149.08	Professional		$121.48	$142.91	$149.08
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $135.83 / $142.91 / $216.07	Professional	25	$135.83	$142.91	$216.07
BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.20 / $105.27 / $135.35	Professional		$80.20	$105.27	$135.35
CareSource Facility/Professional Facility Modifier Low / Median / High Price $86.34 / $108.64 / $112.75	Facility		$86.34	$108.64	$112.75
CareSource Facility/Professional Professional Modifier Low / Median / High Price $135.63 / $142.63 / $176.33	Professional		$135.63	$142.63	$176.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.45 / $111.78 / $180.45	Professional		$66.45	$111.78	$180.45
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $87.75 / $122.14 / $126.26	Facility		$87.75	$122.14	$126.26
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $79.56 / $137.06 / $189.08	Professional		$79.56	$137.06	$189.08
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $224.20 / $230.51 / $257.00	Professional	25	$224.20	$230.51	$257.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $136.48 / $170.59 / $236.61	Professional		$136.48	$170.59	$236.61
United Facility/Professional Professional Modifier Low / Median / High Price $105.48 / $152.25 / $190.42	Professional		$105.48	$152.25	$190.42