Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.98 / $190.61 / $251.16	Facility		$47.98	$190.61	$251.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.94 / $202.81 / $486.27	Professional		$140.94	$202.81	$486.27
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $166.73 / $268.06 / $677.57	Professional	25	$166.73	$268.06	$677.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $183.16 / $222.71 / $314.27	Professional		$183.16	$222.71	$314.27
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $186.96 / $222.71 / $311.35	Professional	25	$186.96	$222.71	$311.35
BCBS Facility/Professional Facility Modifier Low / Median / High Price $180.22 / $211.86 / $456.12	Facility		$180.22	$211.86	$456.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $180.22 / $222.45 / $264.83	Professional		$180.22	$222.45	$264.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $171.43 / $222.86 / $301.37	Facility		$171.43	$222.86	$301.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $213.10 / $270.36 / $425.97	Professional		$213.10	$270.36	$425.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $135.00 / $148.00 / $148.00	Facility		$135.00	$148.00	$148.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.47 / $203.82 / $544.08	Professional		$151.47	$203.82	$544.08
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $47.98 / $201.25 / $261.48	Facility		$47.98	$201.25	$261.48
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $151.31 / $205.92 / $352.29	Professional		$151.31	$205.92	$352.29
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $179.57 / $265.98 / $565.25	Professional	25	$179.57	$265.98	$565.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $188.91 / $236.58 / $338.18	Professional		$188.91	$236.58	$338.18
United Facility/Professional Professional Modifier Low / Median / High Price $179.45 / $218.46 / $284.83	Professional		$179.45	$218.46	$284.83
United Facility/Professional Professional Modifier 25 Low / Median / High Price $80.00 / $80.00 / $88.00	Professional	25	$80.00	$80.00	$88.00