Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $229.09 / $338.84	Facility		$128.82	$229.09	$338.84
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $190.55 / $269.15 / $4,365.16	Facility	25	$190.55	$269.15	$4,365.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $234.42 / $616.60	Professional		$141.25	$234.42	$616.60
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $169.82 / $316.23 / $724.44	Professional	25	$169.82	$316.23	$724.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $218.78 / $302.00	Professional		$165.96	$218.78	$302.00
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $173.78 / $218.78 / $302.00	Professional	25	$173.78	$218.78	$302.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $602.56 / $602.56	Facility		$131.83	$602.56	$602.56
BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $208.93 / $251.19	Professional		$190.55	$208.93	$251.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $141.25 / $162.18	Facility		$120.23	$141.25	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $239.88 / $389.05	Professional		$165.96	$239.88	$389.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $281.84 / $575.44	Professional		$181.97	$281.84	$575.44
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 $213.80 / $251.19 / $302.00	Professional		$213.80	$251.19	$302.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $173.78	Professional		$32.36	$33.11	$173.78
United Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $173.78 / $213.80	Facility		$169.82	$173.78	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $213.80 / $316.23	Professional		$151.36	$213.80	$316.23