Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.60 / $255.61 / $376.99	Facility		$37.60	$255.61	$376.99
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $175.03 / $368.42 / $530.91	Facility	25	$175.03	$368.42	$530.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.83 / $43.73 / $95.70	Professional		$31.83	$43.73	$95.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.31 / $40.63 / $126.60	Professional		$34.31	$40.63	$126.60
BCBS Facility/Professional Facility Modifier Low / Median / High Price $61.89 / $62.25 / $215.86	Facility		$61.89	$62.25	$215.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.50 / $65.36 / $77.81	Professional		$58.50	$65.36	$77.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $39.90 / $51.06 / $81.06	Facility		$39.90	$51.06	$81.06
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.21 / $51.06 / $61.14	Professional		$38.21	$51.06	$61.14
Cigna Facility/Professional Facility Modifier Low / Median / High Price $48.16 / $48.16 / $48.16	Facility		$48.16	$48.16	$48.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.34 / $50.09 / $165.29	Professional		$31.34	$50.09	$165.29
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $37.17 / $253.58 / $376.99	Facility		$37.17	$253.58	$376.99
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $205.42 / $414.83 / $620.57	Facility	25	$205.42	$414.83	$620.57
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $33.17 / $43.72 / $127.44	Professional		$33.17	$43.72	$127.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.57 / $34.44 / $50.18	Professional		$27.57	$34.44	$50.18
United Facility/Professional Professional Modifier Low / Median / High Price $37.35 / $44.80 / $61.15	Professional		$37.35	$44.80	$61.15