Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $891.25 / $1,445.44	Facility		$109.65	$891.25	$1,445.44
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $645.65 / $954.99 / $1,737.80	Facility	25	$645.65	$954.99	$1,737.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $120.23 / $398.11	Professional		$87.10	$120.23	$398.11
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $97.72 / $229.09 / $616.60	Professional	25	$97.72	$229.09	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $125.89 / $199.53	Professional		$109.65	$125.89	$199.53
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $109.65 / $125.89 / $194.98	Professional	25	$109.65	$125.89	$194.98
BCBS Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $204.17 / $616.60	Facility		$177.83	$204.17	$616.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $190.55 / $204.17	Professional		$169.82	$190.55	$204.17
CareSource Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $165.96 / $263.03	Facility		$114.82	$165.96	$263.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $147.91 / $281.84	Professional		$114.82	$147.91	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $134.90 / $467.74	Professional		$97.72	$134.90	$467.74
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $831.76 / $1,318.26	Facility		$107.15	$831.76	$1,318.26
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $602.56 / $933.25 / $1,737.80	Facility	25	$602.56	$933.25	$1,737.80
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $316.23	Professional		$93.33	$125.89	$316.23
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $97.72 / $257.04 / $741.31	Professional	25	$97.72	$257.04	$741.31
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $131.83 / $338.84	Professional		$93.33	$131.83	$338.84
United Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $426.58 / $1,174.90	Facility		$426.58	$426.58	$1,174.90
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $131.83 / $181.97	Professional		$107.15	$131.83	$181.97