Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $177.83 / $281.84	Facility		$114.82	$177.83	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $316.23	Professional		$123.03	$169.82	$316.23
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $138.04 / $194.98 / $501.19	Professional	25	$138.04	$194.98	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $162.18 / $190.55	Professional		$138.04	$162.18	$190.55
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $138.04 / $158.49 / $181.97	Professional	25	$138.04	$158.49	$181.97
BCBS Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $1,584.89 / $3,090.30	Facility		$588.84	$1,584.89	$3,090.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $204.17 / $239.88	Professional		$199.53	$204.17	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $257.04 / $346.74	Professional		$138.04	$257.04	$346.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $251.19 / $457.09	Professional		$181.97	$251.19	$457.09
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 $218.78 / $223.87 / $239.88	Professional		$218.78	$223.87	$239.88
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 $173.78 / $173.78 / $213.80	Facility		$173.78	$173.78	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $186.21 / $309.03	Professional		$138.04	$186.21	$309.03