Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $75.86 / $75.86	Facility		$57.54	$75.86	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $67.61 / $100.00	Professional		$51.29	$67.61	$100.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $58.88 / $72.44 / $75.86	Professional	25	$58.88	$72.44	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $66.07 / $75.86	Professional		$56.23	$66.07	$75.86
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $56.23 / $70.79 / $79.43	Professional	25	$56.23	$70.79	$79.43
BCBS Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $125.89	Facility		$109.65	$109.65	$125.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $125.89	Professional		$109.65	$109.65	$125.89
CareSource Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Facility		$95.50	$95.50	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $97.72 / $177.83	Professional		$56.23	$97.72	$177.83
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $75.86 / $190.55	Facility		$64.57	$75.86	$190.55
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $72.44 / $104.71	Professional		$54.95	$72.44	$104.71
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $58.88 / $58.88 / $75.86	Professional	25	$58.88	$58.88	$75.86
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $107.15 / $177.83	Professional		$56.23	$107.15	$177.83
United Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $56.23 / $83.18	Facility		$56.23	$56.23	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $74.13 / $102.33	Professional		$60.26	$74.13	$102.33