Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $106.00 / $154.52 / $193.05	Facility		$106.00	$154.52	$193.05
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $215.84 / $380.01 / $393.71	Facility	25	$215.84	$380.01	$393.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.41 / $154.84 / $351.94	Professional		$98.41	$154.84	$351.94
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $108.90 / $197.56 / $399.95	Professional	25	$108.90	$197.56	$399.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.26 / $179.69 / $258.01	Professional		$136.26	$179.69	$258.01
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $144.37 / $179.69 / $258.01	Professional	25	$144.37	$179.69	$258.01
BCBS Facility/Professional Facility Modifier Low / Median / High Price $128.54 / $157.72 / $372.65	Facility		$128.54	$157.72	$372.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.54 / $165.62 / $197.16	Professional		$128.54	$165.62	$197.16
CareSource Facility/Professional Facility Modifier Low / Median / High Price $135.31 / $171.65 / $202.97	Facility		$135.31	$171.65	$202.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $174.34 / $219.57 / $344.23	Professional		$174.34	$219.57	$344.23
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 $103.15 / $149.78 / $402.55	Professional		$103.15	$149.78	$402.55
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $106.00 / $154.52 / $354.51	Facility		$106.00	$154.52	$354.51
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $215.84 / $380.01 / $393.71	Facility	25	$215.84	$380.01	$393.71
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $110.65 / $154.84 / $277.08	Professional		$110.65	$154.84	$277.08
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $105.62 / $186.73 / $355.96	Professional	25	$105.62	$186.73	$355.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $135.10 / $168.71 / $241.51	Professional		$135.10	$168.71	$241.51
United Facility/Professional Professional Modifier Low / Median / High Price $124.28 / $153.91 / $230.37	Professional		$124.28	$153.91	$230.37