Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $1,621.81 / $3,090.30	Facility		$218.78	$1,621.81	$3,090.30
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $870.96 / $2,570.40 / $3,162.28	Facility	25	$870.96	$2,570.40	$3,162.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $251.19 / $794.33	Professional		$177.83	$251.19	$794.33
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $190.55 / $354.81 / $1,047.13	Professional	25	$190.55	$354.81	$1,047.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $229.09 / $380.19	Professional		$177.83	$229.09	$380.19
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $190.55 / $257.04 / $389.05	Professional	25	$190.55	$257.04	$389.05
BCBS Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $316.23 / $1,513.56	Facility		$316.23	$316.23	$1,513.56
BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $338.84 / $338.84	Professional		$302.00	$338.84	$338.84
CareSource Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $275.42 / $446.68	Facility		$204.17	$275.42	$446.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $338.84 / $616.60	Professional		$257.04	$338.84	$616.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $281.84 / $602.56	Professional		$204.17	$281.84	$602.56
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $1,202.26 / $2,951.21	Facility		$218.78	$1,202.26	$2,951.21
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $831.76 / $2,570.40 / $3,162.28	Facility	25	$831.76	$2,570.40	$3,162.28
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $281.84 / $645.65	Professional		$186.21	$281.84	$645.65
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $190.55 / $398.11 / $1,023.29	Professional	25	$190.55	$398.11	$1,023.29
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $269.15 / $537.03	Professional		$186.21	$269.15	$537.03
United Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $223.87 / $2,290.87	Facility		$204.17	$223.87	$2,290.87
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $269.15 / $407.38	Professional		$208.93	$269.15	$407.38