Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $64.75 / $485.30 / $824.67	Facility		$64.75	$485.30	$824.67
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $278.57 / $617.95 / $1,050.00	Facility	25	$278.57	$617.95	$1,050.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.57 / $67.65 / $164.38	Professional		$52.57	$67.65	$164.38
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $70.06 / $149.41 / $377.30	Professional	25	$70.06	$149.41	$377.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.05 / $93.55 / $244.41	Professional		$66.05	$93.55	$244.41
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $67.20 / $87.35 / $248.81	Professional	25	$67.20	$87.35	$248.81
BCBS Facility/Professional Facility Modifier Low / Median / High Price $89.91 / $105.08 / $362.38	Facility		$89.91	$105.08	$362.38
BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.52 / $110.33 / $131.35	Professional		$95.52	$110.33	$131.35
CareSource Facility/Professional Facility Modifier Low / Median / High Price $67.41 / $86.33 / $145.28	Facility		$67.41	$86.33	$145.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $64.70 / $86.33 / $103.52	Professional		$64.70	$86.33	$103.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $82.02 / $82.02 / $82.02	Facility		$82.02	$82.02	$82.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.89 / $88.19 / $282.93	Professional		$59.89	$88.19	$282.93
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $63.89 / $474.75 / $878.20	Facility		$63.89	$474.75	$878.20
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $295.45 / $697.44 / $982.80	Facility	25	$295.45	$697.44	$982.80
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $56.38 / $71.95 / $165.28	Professional		$56.38	$71.95	$165.28
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $70.06 / $273.87 / $659.74	Professional	25	$70.06	$273.87	$659.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $55.15 / $68.89 / $99.67	Professional		$55.15	$68.89	$99.67
United Facility/Professional Professional Modifier Low / Median / High Price $59.76 / $69.72 / $99.60	Professional		$59.76	$69.72	$99.60