Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.84 / $922.00 / $3,983.00	Facility		$137.84	$922.00	$3,983.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $711.12 / $2,020.84 / $4,734.02	Facility	25	$711.12	$2,020.84	$4,734.02
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $148.88 / $379.85 / $800.95	Professional	25	$148.88	$379.85	$800.95
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $161.84 / $205.63 / $541.21	Professional	25	$161.84	$205.63	$541.21
CareSource Facility/Professional Facility Modifier Low / Median / High Price $167.03 / $192.08 / $250.55	Facility		$167.03	$192.08	$250.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $202.43 / $202.43 / $2,874.00	Facility		$202.43	$202.43	$2,874.00
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $202.43 / $1,193.20 / $2,874.00	Facility		$202.43	$1,193.20	$2,874.00