Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $123.03 / $123.03	Facility		$25.12	$123.03	$123.03
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $14.13 / $87.10 / $125.89	Facility	25	$14.13	$87.10	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $125.89 / $275.42	Professional		$63.10	$125.89	$275.42
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $31.62 / $141.25 / $223.87	Professional	25	$31.62	$141.25	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $114.82 / $181.97	Professional		$102.33	$114.82	$181.97
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $107.15 / $114.82 / $120.23	Professional	25	$107.15	$114.82	$120.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $87.10 / $144.54	Professional		$81.28	$87.10	$144.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $91.20 / $100.00	Facility		$69.18	$91.20	$100.00
CareSource Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $114.82 / $123.03	Professional		$112.20	$114.82	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $97.72 / $316.23	Professional		$54.95	$97.72	$316.23
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $123.03 / $123.03	Facility		$25.12	$123.03	$123.03
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $14.13 / $87.10 / $125.89	Facility	25	$14.13	$87.10	$125.89
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $112.20 / $190.55	Professional		$58.88	$112.20	$190.55
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $91.20 / $138.04 / $204.17	Professional	25	$91.20	$138.04	$204.17
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $93.33 / $208.93	Professional		$61.66	$93.33	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $102.33 / $147.91	Professional		$69.18	$102.33	$147.91