Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $93.33 / $302.00	Facility		$53.70	$93.33	$302.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $67.61 / $138.04 / $234.42	Facility	25	$67.61	$138.04	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $81.28 / $173.78	Professional		$50.12	$81.28	$173.78
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $52.48 / $87.10 / $199.53	Professional	25	$52.48	$87.10	$199.53
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $263.03 / $263.03 / $263.03	Professional	50	$263.03	$263.03	$263.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $83.18 / $117.49	Professional		$54.95	$83.18	$117.49
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $67.61 / $87.10 / $123.03	Professional	25	$67.61	$87.10	$123.03
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $75.86 / $75.86 / $75.86	Professional	50	$75.86	$75.86	$75.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $85.11 / $138.04	Professional		$54.95	$85.11	$138.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $120.23 / $208.93	Facility		$102.33	$120.23	$208.93
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $123.03 / $123.03 / $123.03	Facility	22	$123.03	$123.03	$123.03
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $63.10 / $63.10 / $63.10	Facility	62	$63.10	$63.10	$63.10
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $10.23 / $10.23 / $10.23	Facility	AS	$10.23	$10.23	$10.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $75.86 / $131.83	Professional		$51.29	$75.86	$131.83
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $630.96 / $630.96	Facility		$630.96	$630.96	$630.96
Lucent Health Facility/Professional Facility Modifier 62 Low / Median / High Price $257.04 / $257.04 / $257.04	Facility	62	$257.04	$257.04	$257.04
Lucent Health Facility/Professional Facility Modifier AS Low / Median / High Price $41.69 / $41.69 / $41.69	Facility	AS	$41.69	$41.69	$41.69
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $562.34 / $562.34	Professional		$95.50	$562.34	$562.34
Optum Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $87.10 / $120.23	Professional		$48.98	$87.10	$120.23
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $69.18 / $109.65	Professional		$44.67	$69.18	$109.65