Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $219.66 / $2,035.80 / $3,494.40	Facility		$219.66	$2,035.80	$3,494.40
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $349.35 / $2,736.30 / $3,360.00	Facility	25	$349.35	$2,736.30	$3,360.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.58 / $223.53 / $680.40	Professional		$171.58	$223.53	$680.40
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $43.79 / $600.07 / $1,422.90	Professional	25	$43.79	$600.07	$1,422.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $192.43 / $202.26 / $333.73	Professional		$192.43	$202.26	$333.73
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $202.26 / $202.26 / $205.90	Professional	25	$202.26	$202.26	$205.90
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,561.64 / $2,724.69 / $4,310.55	Facility		$1,561.64	$2,724.69	$4,310.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $149.56 / $250.44 / $390.30	Professional		$149.56	$250.44	$390.30
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 $225.14 / $333.16 / $491.48	Professional		$225.14	$333.16	$491.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $421.00	Professional		$32.34	$32.34	$421.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $187.94 / $260.83 / $384.96	Facility		$187.94	$260.83	$384.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $247.18 / $382.21 / $636.48	Professional		$247.18	$382.21	$636.48
United Facility/Professional Facility Modifier Low / Median / High Price $3,685.34 / $3,685.34 / $3,685.34	Facility		$3,685.34	$3,685.34	$3,685.34
United Facility/Professional Professional Modifier Low / Median / High Price $294.50 / $394.50 / $569.50	Professional		$294.50	$394.50	$569.50