Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.26 / $93.52 / $194.78	Facility		$58.26	$93.52	$194.78
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $74.55 / $136.06 / $185.10	Facility	25	$74.55	$136.06	$185.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.99 / $75.33 / $171.06	Professional		$46.99	$75.33	$171.06
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $52.30 / $85.00 / $194.02	Professional	25	$52.30	$85.00	$194.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $262.68 / $262.68 / $271.76	Professional	50	$262.68	$262.68	$271.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.53 / $90.90 / $144.00	Professional		$61.53	$90.90	$144.00
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $66.14 / $90.90 / $143.75	Professional	25	$66.14	$90.90	$143.75
BCBS Facility/Professional Facility Modifier Low / Median / High Price $107.20 / $189.32 / $329.72	Facility		$107.20	$189.32	$329.72
BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $47.70 / $86.41	Professional		$36.00	$47.70	$86.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $88.08 / $238.15	Facility		$88.08	$88.08	$238.15
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 $47.55 / $72.45 / $126.36	Professional		$47.55	$72.45	$126.36
Medcost Facility/Professional Facility Modifier Low / Median / High Price $50.23 / $71.15 / $124.87	Facility		$50.23	$71.15	$124.87
Medcost Facility/Professional Facility Modifier 50 Low / Median / High Price $76.73 / $87.00 / $183.92	Facility	50	$76.73	$87.00	$183.92
Medcost Facility/Professional Facility Modifier 80 Low / Median / High Price $10.23 / $11.60 / $24.52	Facility	80	$10.23	$11.60	$24.52
Medcost Facility/Professional Facility Modifier AS Low / Median / High Price $7.16 / $8.26 / $17.17	Facility	AS	$7.16	$8.26	$17.17
Medcost Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $57.00 / $90.00	Professional		$40.00	$57.00	$90.00
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $85.50 / $85.50 / $90.32	Professional	50	$85.50	$85.50	$90.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.90 / $74.75 / $117.88	Professional		$54.90	$74.75	$117.88
United Facility/Professional Professional Modifier Low / Median / High Price $55.26 / $71.51 / $122.46	Professional		$55.26	$71.51	$122.46