Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $111.17 / $128.52 / $462.62	Facility		$111.17	$128.52	$462.62
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $688.50 / $1,860.84 / $2,884.89	Facility	25	$688.50	$1,860.84	$2,884.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.95 / $111.17 / $326.00	Professional		$90.95	$111.17	$326.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $109.37 / $266.14 / $818.00	Professional	25	$109.37	$266.14	$818.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.96 / $115.44 / $175.00	Professional		$101.96	$115.44	$175.00
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $97.55 / $107.63 / $320.19	Professional	25	$97.55	$107.63	$320.19
BCBS Facility/Professional Facility Modifier Low / Median / High Price $158.36 / $980.29 / $1,568.47	Facility		$158.36	$980.29	$1,568.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $142.52 / $166.28 / $197.95	Professional		$142.52	$166.28	$197.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $101.01 / $126.82 / $164.03	Facility		$101.01	$126.82	$164.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $110.47 / $146.26 / $185.30	Professional		$110.47	$146.26	$185.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $143.15 / $143.15 / $143.15	Facility		$143.15	$143.15	$143.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.06 / $131.22 / $364.91	Professional		$96.06	$131.22	$364.91
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $111.17 / $135.16 / $1,124.97	Facility		$111.17	$135.16	$1,124.97
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $688.50 / $848.49 / $2,884.89	Facility	25	$688.50	$848.49	$2,884.89
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $96.43 / $123.49 / $371.94	Professional		$96.43	$123.49	$371.94
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $109.60 / $369.60 / $1,255.60	Professional	25	$109.60	$369.60	$1,255.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.05 / $101.62 / $147.23	Professional		$81.05	$101.62	$147.23
United Facility/Professional Professional Modifier Low / Median / High Price $110.15 / $132.25 / $183.86	Professional		$110.15	$132.25	$183.86
United Facility/Professional Professional Modifier 25 Low / Median / High Price $80.00 / $80.00 / $144.66	Professional	25	$80.00	$80.00	$144.66