Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.09 / $78.67 / $108.02	Facility		$67.09	$78.67	$108.02
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $41.40 / $124.30 / $170.00	Facility	25	$41.40	$124.30	$170.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.47 / $75.00 / $164.80	Professional		$50.47	$75.00	$164.80
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $51.42 / $87.37 / $194.28	Professional	25	$51.42	$87.37	$194.28
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 $62.50 / $85.49 / $118.82	Professional		$62.50	$85.49	$118.82
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $74.59 / $86.34 / $112.24	Professional	25	$74.59	$86.34	$112.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.40 / $65.66 / $110.30	Professional		$39.40	$65.66	$110.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $140.00 / $175.00	Facility		$88.08	$140.00	$175.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.95 / $87.51 / $131.06	Professional		$55.95	$87.51	$131.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $77.34 / $139.35	Professional		$32.34	$77.34	$139.35
Providence Facility/Professional Facility Modifier Low / Median / High Price $42.30 / $70.13 / $93.51	Facility		$42.30	$70.13	$93.51
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.39 / $95.00 / $175.21	Professional		$58.39	$95.00	$175.21
United Facility/Professional Professional Modifier Low / Median / High Price $76.93 / $103.39 / $149.81	Professional		$76.93	$103.39	$149.81