Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $112.20 / $218.78	Facility		$53.70	$112.20	$218.78
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $97.72 / $173.78 / $234.42	Facility	25	$97.72	$173.78	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $117.49 / $295.12	Professional		$67.61	$117.49	$295.12
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $72.44 / $125.89 / $295.12	Professional	25	$72.44	$125.89	$295.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $107.15 / $151.36	Professional		$79.43	$107.15	$151.36
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $87.10 / $109.65 / $151.36	Professional	25	$87.10	$109.65	$151.36
BCBS Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $181.97 / $309.03	Facility		$46.77	$181.97	$309.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $100.00 / $128.82	Professional		$87.10	$100.00	$128.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $134.90 / $158.49	Facility		$120.23	$134.90	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $120.23 / $199.53	Professional		$79.43	$120.23	$199.53
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $138.04 / $263.03	Professional		$89.13	$138.04	$263.03
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $102.33 / $138.04	Professional		$87.10	$102.33	$138.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $165.96	Professional		$32.36	$33.11	$165.96
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $79.43 / $109.65	Facility		$69.18	$79.43	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $104.71 / $162.18	Professional		$70.79	$104.71	$162.18