Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $131.83 / $177.83	Facility		$93.33	$131.83	$177.83
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $50.12 / $50.12 / $416.87	Facility	25	$50.12	$50.12	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $173.78 / $436.52	Professional		$107.15	$173.78	$436.52
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $123.03 / $204.17 / $501.19	Professional	25	$123.03	$204.17	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $162.18 / $223.87	Professional		$123.03	$162.18	$223.87
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $128.82 / $162.18 / $223.87	Professional	25	$128.82	$162.18	$223.87
BCBS Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $177.83 / $204.17	Facility		$165.96	$177.83	$204.17
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $194.98 / $239.88	Professional		$151.36	$194.98	$239.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $173.78 / $263.03	Facility		$125.89	$173.78	$263.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $199.53 / $371.54	Professional		$154.88	$199.53	$371.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $147.91 / $204.17	Facility		$134.90	$147.91	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $162.18 / $354.81	Professional		$120.23	$162.18	$354.81
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $138.04 / $190.55	Facility		$100.00	$138.04	$190.55
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $50.12 / $50.12 / $416.87	Facility	25	$50.12	$50.12	$416.87
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $162.18 / $354.81	Professional		$104.71	$162.18	$354.81
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $117.49 / $199.53 / $467.74	Professional	25	$117.49	$199.53	$467.74
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $147.91 / $204.17	Facility		$134.90	$147.91	$204.17
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $154.88 / $309.03	Professional		$120.23	$154.88	$309.03
United Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $134.90 / $141.25	Facility		$114.82	$134.90	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $158.49 / $234.42	Professional		$117.49	$158.49	$234.42