Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.71 / $76.06 / $175.20	Facility		$53.71	$76.06	$175.20
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $99.86 / $159.13 / $200.57	Facility	25	$99.86	$159.13	$200.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.15 / $83.73 / $177.66	Professional		$51.15	$83.73	$177.66
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $50.74 / $93.34 / $198.90	Professional	25	$50.74	$93.34	$198.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $254.64 / $262.68 / $271.76	Professional	50	$254.64	$262.68	$271.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $62.64 / $87.07 / $128.44	Professional		$62.64	$87.07	$128.44
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $70.54 / $90.79 / $134.85	Professional	25	$70.54	$90.79	$134.85
BCBS Facility/Professional Facility Modifier Low / Median / High Price $80.23 / $90.28 / $257.77	Facility		$80.23	$90.28	$257.77
BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.98 / $85.82 / $100.30	Professional		$73.98	$85.82	$100.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $62.19 / $80.84 / $108.68	Facility		$62.19	$80.84	$108.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $88.07 / $110.72 / $173.04	Professional		$88.07	$110.72	$173.04
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 $48.18 / $72.81 / $205.40	Professional		$48.18	$72.81	$205.40
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $52.07 / $77.84 / $187.00	Facility		$52.07	$77.84	$187.00
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $47.98 / $166.64 / $430.97	Facility	25	$47.98	$166.64	$430.97
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $52.90 / $78.81 / $153.00	Professional		$52.90	$78.81	$153.00
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $45.63 / $89.40 / $187.34	Professional	25	$45.63	$89.40	$187.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.68 / $67.87 / $96.25	Professional		$54.68	$67.87	$96.25
United Facility/Professional Professional Modifier Low / Median / High Price $59.12 / $76.15 / $106.10	Professional		$59.12	$76.15	$106.10