Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $489.78 / $870.96	Facility		$64.57	$489.78	$870.96
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $302.00 / $645.65 / $954.99	Facility	25	$302.00	$645.65	$954.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $70.79 / $208.93	Professional		$52.48	$70.79	$208.93
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $66.07 / $144.54 / $407.38	Professional	25	$66.07	$144.54	$407.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $85.11 / $147.91	Professional		$54.95	$85.11	$147.91
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $57.54 / $77.62 / $107.15	Professional	25	$57.54	$77.62	$107.15
BCBS Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $104.71 / $363.08	Facility		$89.13	$104.71	$363.08
BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $112.20 / $123.03	Professional		$100.00	$112.20	$123.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $97.72 / $151.36	Facility		$67.61	$97.72	$151.36
CareSource Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $87.10 / $162.18	Professional		$66.07	$87.10	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $245.47	Professional		$54.95	$74.13	$245.47
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $446.68 / $831.76	Facility		$64.57	$446.68	$831.76
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $281.84 / $616.60 / $954.99	Facility	25	$281.84	$616.60	$954.99
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $72.44 / $173.78	Professional		$53.70	$72.44	$173.78
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $66.07 / $154.88 / $426.58	Professional	25	$66.07	$154.88	$426.58
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $72.44 / $199.53	Professional		$53.70	$72.44	$199.53
United Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $281.84 / $758.58	Facility		$281.84	$281.84	$758.58
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $70.79 / $109.65	Professional		$58.88	$70.79	$109.65