Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $202.48 / $1,956.71 / $2,526.34	Facility		$202.48	$1,956.71	$2,526.34
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $754.39 / $992.99 / $1,956.71	Facility	25	$754.39	$992.99	$1,956.71
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $160.07 / $268.80 / $795.11	Professional	25	$160.07	$268.80	$795.11
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $184.73 / $219.67 / $598.94	Professional	25	$184.73	$219.67	$598.94
CareSource Facility/Professional Facility Modifier Low / Median / High Price $167.03 / $217.14 / $496.33	Facility		$167.03	$217.14	$496.33
Qualchoice Facility/Professional Professional Modifier 25 Low / Median / High Price $212.44 / $252.62 / $698.48	Professional	25	$212.44	$252.62	$698.48