Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $134.90 / $162.18	Facility		$107.15	$134.90	$162.18
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $162.18 / $162.18 / $218.78	Facility	25	$162.18	$162.18	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $151.36 / $323.59	Professional		$95.50	$151.36	$323.59
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $95.50 / $177.83 / $363.08	Professional	25	$95.50	$177.83	$363.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $169.82 / $223.87	Professional		$120.23	$169.82	$223.87
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $134.90 / $177.83 / $234.42	Professional	25	$134.90	$177.83	$234.42
BCBS Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $144.54 / $199.53	Facility		$144.54	$144.54	$199.53
BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $190.55	Professional		$104.71	$144.54	$190.55
CareSource Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $177.83 / $251.19	Facility		$134.90	$177.83	$251.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $194.98 / $398.11	Professional		$169.82	$194.98	$398.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $128.82 / $147.91	Facility		$95.50	$128.82	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $245.47	Professional		$112.20	$151.36	$245.47
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $208.93 / $269.15	Professional		$162.18	$208.93	$269.15
Qualchoice Facility/Professional Professional Modifier 25 Low / Median / High Price $165.96 / $218.78 / $269.15	Professional	25	$165.96	$218.78	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $134.90 / $190.55	Professional		$100.00	$134.90	$190.55