Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.18 / $117.04 / $216.53	Facility		$79.18	$117.04	$216.53
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $216.53 / $217.78 / $326.45	Facility	25	$216.53	$217.78	$326.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.43 / $119.77 / $266.74	Professional		$69.43	$119.77	$266.74
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $68.12 / $135.75 / $311.60	Professional	25	$68.12	$135.75	$311.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $94.50 / $293.95 / $300.77	Professional	50	$94.50	$293.95	$300.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.25 / $124.54 / $181.26	Professional		$92.25	$124.54	$181.26
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $102.71 / $128.04 / $181.26	Professional	25	$102.71	$128.04	$181.26
BCBS Facility/Professional Facility Modifier Low / Median / High Price $105.39 / $116.96 / $289.38	Facility		$105.39	$116.96	$289.38
BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.39 / $125.67 / $145.44	Professional		$105.39	$125.67	$145.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $91.58 / $119.05 / $160.51	Facility		$91.58	$119.05	$160.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $124.05 / $156.21 / $244.65	Professional		$124.05	$156.21	$244.65
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 $70.81 / $107.78 / $295.20	Professional		$70.81	$107.78	$295.20
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $75.90 / $111.75 / $281.29	Facility		$75.90	$111.75	$281.29
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $114.05 / $249.15 / $386.56	Facility	25	$114.05	$249.15	$386.56
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $75.18 / $110.29 / $232.75	Professional		$75.18	$110.29	$232.75
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $64.81 / $122.78 / $286.54	Professional	25	$64.81	$122.78	$286.54
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $293.95 / $293.95 / $300.77	Professional	50	$293.95	$293.95	$300.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $107.61 / $134.94 / $192.02	Professional		$107.61	$134.94	$192.02
United Facility/Professional Professional Modifier Low / Median / High Price $81.95 / $110.43 / $148.16	Professional		$81.95	$110.43	$148.16