Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $288.40 / $2,398.83	Facility		$239.88	$288.40	$2,398.83
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $912.01 / $1,380.38 / $2,570.40	Facility	25	$912.01	$1,380.38	$2,570.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $239.88 / $1,148.15	Professional		$169.82	$239.88	$1,148.15
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $194.98 / $371.54 / $1,318.26	Professional	25	$194.98	$371.54	$1,318.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $234.42 / $354.81	Professional		$190.55	$234.42	$354.81
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $194.98 / $239.88 / $354.81	Professional	25	$194.98	$239.88	$354.81
BCBS Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $371.54 / $371.54	Facility		$371.54	$371.54	$371.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $269.15 / $363.08	Professional		$190.55	$269.15	$363.08
CareSource Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $263.03 / $416.87	Facility		$204.17	$263.03	$416.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $346.74 / $616.60	Professional		$257.04	$346.74	$616.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $275.42 / $416.87	Professional		$204.17	$275.42	$416.87
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $302.00 / $645.65	Professional		$245.47	$302.00	$645.65
Qualchoice Facility/Professional Professional Modifier 25 Low / Median / High Price $269.15 / $302.00 / $524.81	Professional	25	$269.15	$302.00	$524.81
United Facility/Professional Facility Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility		$1,000.00	$1,000.00	$1,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $263.03 / $354.81	Professional		$204.17	$263.03	$354.81