Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $57.54 / $131.83	Facility		$31.62	$57.54	$131.83
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $67.61 / $102.33 / $478.63	Facility	25	$67.61	$102.33	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $53.70 / $123.03	Professional		$28.84	$53.70	$123.03
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $33.11 / $58.88 / $134.90	Professional	25	$33.11	$58.88	$134.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $52.48 / $72.44	Professional		$30.90	$52.48	$72.44
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $38.90 / $54.95 / $74.13	Professional	25	$38.90	$54.95	$74.13
BCBS Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $52.48 / $60.26	Facility		$50.12	$52.48	$60.26
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $57.54 / $74.13	Professional		$46.77	$57.54	$74.13
CareSource Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $45.71 / $69.18	Facility		$33.11	$45.71	$69.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $66.07 / $123.03	Professional		$51.29	$66.07	$123.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $134.90 / $147.91	Facility		$54.95	$134.90	$147.91
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	22	$64.57	$64.57	$64.57
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $33.88 / $33.88 / $33.88	Facility	62	$33.88	$33.88	$33.88
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $5.37 / $5.37 / $5.37	Facility	AS	$5.37	$5.37	$5.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $45.71 / $102.33	Professional		$26.92	$45.71	$102.33
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $57.54 / $131.83	Facility		$31.62	$57.54	$131.83
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $67.61 / $102.33 / $389.05	Facility	25	$67.61	$102.33	$389.05
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $47.86 / $104.71	Professional		$27.54	$47.86	$104.71
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $32.36 / $58.88 / $125.89	Professional	25	$32.36	$58.88	$125.89
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $134.90 / $147.91	Facility		$54.95	$134.90	$147.91
Priority Health Facility/Professional Facility Modifier 22 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	22	$64.57	$64.57	$64.57
Priority Health Facility/Professional Facility Modifier 62 Low / Median / High Price $33.88 / $33.88 / $33.88	Facility	62	$33.88	$33.88	$33.88
Priority Health Facility/Professional Facility Modifier AS Low / Median / High Price $5.37 / $5.37 / $5.37	Facility	AS	$5.37	$5.37	$5.37
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $43.65 / $85.11	Professional		$26.30	$43.65	$85.11
United Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $35.48 / $39.81	Facility		$32.36	$35.48	$39.81
United Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $40.74 / $66.07	Professional		$24.55	$40.74	$66.07