Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.26 / $25.26 / $124.27	Facility		$25.26	$25.26	$124.27
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $49.19 / $87.75 / $124.27	Facility	25	$49.19	$87.75	$124.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.09 / $104.45 / $166.25	Professional		$64.09	$104.45	$166.25
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $74.79 / $154.97 / $178.20	Professional	25	$74.79	$154.97	$178.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.56 / $121.01 / $121.01	Professional		$114.56	$121.01	$121.01
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $114.64 / $121.01 / $121.01	Professional	25	$114.64	$121.01	$121.01
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.81 / $85.06 / $109.36	Professional		$64.81	$85.06	$109.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $69.52 / $87.68 / $90.95	Facility		$69.52	$87.68	$90.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $114.45 / $120.29 / $148.79	Professional		$114.45	$120.29	$148.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.16 / $93.55 / $150.38	Professional		$56.16	$93.55	$150.38
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $25.26 / $122.98 / $124.27	Facility		$25.26	$122.98	$124.27
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $14.00 / $49.19 / $124.27	Facility	25	$14.00	$49.19	$124.27
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $113.49 / $158.76	Professional		$50.00	$113.49	$158.76
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $74.79 / $154.97 / $191.35	Professional	25	$74.79	$154.97	$191.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.79 / $102.24 / $141.24	Professional		$81.79	$102.24	$141.24
United Facility/Professional Professional Modifier Low / Median / High Price $108.90 / $132.03 / $160.15	Professional		$108.90	$132.03	$160.15