Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $108.20 / $913.10 / $1,544.40	Facility		$108.20	$913.10	$1,544.40
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $599.76 / $945.22 / $1,807.36	Facility	25	$599.76	$945.22	$1,807.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.09 / $126.03 / $330.32	Professional		$93.09	$126.03	$330.32
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $98.57 / $290.57 / $633.00	Professional	25	$98.57	$290.57	$633.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.12 / $166.31 / $460.34	Professional		$115.12	$166.31	$460.34
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $109.75 / $123.19 / $175.78	Professional	25	$109.75	$123.19	$175.78
BCBS Facility/Professional Facility Modifier Low / Median / High Price $179.28 / $205.47 / $621.73	Facility		$179.28	$205.47	$621.73
BCBS Facility/Professional Professional Modifier Low / Median / High Price $168.89 / $188.24 / $224.10	Professional		$168.89	$188.24	$224.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $115.12 / $147.37 / $248.24	Facility		$115.12	$147.37	$248.24
CareSource Facility/Professional Professional Modifier Low / Median / High Price $110.18 / $147.37 / $176.29	Professional		$110.18	$147.37	$176.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $139.63 / $139.63 / $139.63	Facility		$139.63	$139.63	$139.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.18 / $152.87 / $488.81	Professional		$102.18	$152.87	$488.81
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $107.35 / $811.68 / $1,455.95	Facility		$107.35	$811.68	$1,455.95
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $617.95 / $982.16 / $1,754.30	Facility	25	$617.95	$982.16	$1,754.30
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $94.73 / $126.31 / $280.42	Professional		$94.73	$126.31	$280.42
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $101.58 / $421.11 / $913.10	Professional	25	$101.58	$421.11	$913.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $108.46 / $135.99 / $196.61	Professional		$108.46	$135.99	$196.61
United Facility/Professional Professional Modifier Low / Median / High Price $109.78 / $130.37 / $176.47	Professional		$109.78	$130.37	$176.47