Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $131.83 / $208.93	Facility		$85.11	$131.83	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $245.47	Professional		$93.33	$125.89	$245.47
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $128.82 / $128.82 / $128.82	Professional	25	$128.82	$128.82	$128.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $117.49 / $138.04	Professional		$100.00	$117.49	$138.04
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $102.33 / $117.49 / $131.83	Professional	25	$102.33	$117.49	$131.83
BCBS Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $537.03 / $2,089.30	Facility		$263.03	$537.03	$2,089.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $154.88 / $177.83	Professional		$151.36	$154.88	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $190.55 / $257.04	Professional		$112.20	$190.55	$257.04
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $331.13	Professional		$134.90	$190.55	$331.13
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $165.96 / $173.78	Professional		$158.49	$165.96	$173.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $173.78	Professional		$32.36	$33.11	$173.78
United Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $162.18	Facility		$128.82	$128.82	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $144.54 / $239.88	Professional		$109.65	$144.54	$239.88