Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $221.25 / $1,856.37 / $3,980.08	Facility		$221.25	$1,856.37	$3,980.08
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $794.24 / $2,594.19 / $2,918.67	Facility	25	$794.24	$2,594.19	$2,918.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.23 / $239.91 / $632.24	Professional		$183.23	$239.91	$632.24
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $189.83 / $348.02 / $985.95	Professional	25	$189.83	$348.02	$985.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $200.06 / $215.74 / $367.38	Professional		$200.06	$215.74	$367.38
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $173.49 / $208.18 / $364.50	Professional	25	$173.49	$208.18	$364.50
BCBS Facility/Professional Facility Modifier Low / Median / High Price $316.70 / $945.85 / $1,513.36	Facility		$316.70	$945.85	$1,513.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $287.92 / $332.55 / $427.56	Professional		$287.92	$332.55	$427.56
CareSource Facility/Professional Facility Modifier Low / Median / High Price $202.11 / $253.25 / $333.48	Facility		$202.11	$253.25	$333.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $251.32 / $333.61 / $422.63	Professional		$251.32	$333.61	$422.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $286.33 / $286.33 / $286.33	Facility		$286.33	$286.33	$286.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.88 / $279.92 / $829.00	Professional		$201.88	$279.92	$829.00
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $221.25 / $2,030.13 / $3,118.28	Facility		$221.25	$2,030.13	$3,118.28
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $805.25 / $2,594.19 / $2,948.04	Facility	25	$805.25	$2,594.19	$2,948.04
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $192.09 / $267.70 / $526.44	Professional		$192.09	$267.70	$526.44
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $197.46 / $486.75 / $1,098.00	Professional	25	$197.46	$486.75	$1,098.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $215.66 / $270.51 / $392.20	Professional		$215.66	$270.51	$392.20
United Facility/Professional Facility Modifier Low / Median / High Price $614.22 / $1,700.93 / $2,371.85	Facility		$614.22	$1,700.93	$2,371.85
United Facility/Professional Professional Modifier Low / Median / High Price $244.12 / $298.99 / $459.43	Professional		$244.12	$298.99	$459.43