Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $104.71 / $218.78	Facility		$63.10	$104.71	$218.78
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $50.12 / $218.78 / $331.13	Facility	25	$50.12	$218.78	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $123.03 / $295.12	Professional		$61.66	$123.03	$295.12
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $63.10 / $128.82 / $331.13	Professional	25	$63.10	$128.82	$331.13
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $95.50 / $295.12 / $302.00	Professional	50	$95.50	$295.12	$302.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $117.49 / $162.18	Professional		$81.28	$117.49	$162.18
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $89.13 / $123.03 / $165.96	Professional	25	$89.13	$123.03	$165.96
BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $123.03 / $181.97	Facility		$100.00	$123.03	$181.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $128.82 / $154.88	Professional		$104.71	$128.82	$154.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $125.89 / $190.55	Facility		$91.20	$125.89	$190.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $151.36 / $281.84	Professional		$117.49	$151.36	$281.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $147.91 / $151.36	Facility		$134.90	$147.91	$151.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $112.20 / $251.19	Professional		$75.86	$112.20	$251.19
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $107.15 / $194.98	Facility		$75.86	$107.15	$194.98
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $50.12 / $218.78 / $331.13	Facility	25	$50.12	$218.78	$331.13
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $112.20 / $257.04	Professional		$66.07	$112.20	$257.04
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $63.10 / $128.82 / $309.03	Professional	25	$63.10	$128.82	$309.03
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $95.50 / $295.12 / $302.00	Professional	50	$95.50	$295.12	$302.00
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $147.91 / $151.36	Facility		$134.90	$147.91	$151.36
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $104.71 / $208.93	Professional		$75.86	$104.71	$208.93
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $87.10 / $87.10	Facility		$69.18	$87.10	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $102.33 / $162.18	Professional		$70.79	$102.33	$162.18