Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $105.14 / $143.72 / $206.29	Facility		$105.14	$143.72	$206.29
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $288.52 / $288.52 / $288.52	Facility	25	$288.52	$288.52	$288.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.27 / $161.52 / $284.50	Professional		$115.27	$161.52	$284.50
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $149.58 / $212.13 / $354.35	Professional	25	$149.58	$212.13	$354.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.16 / $173.34 / $225.34	Professional		$151.16	$173.34	$225.34
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $173.34 / $173.34 / $265.11	Professional	25	$173.34	$173.34	$265.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $150.63 / $150.75 / $150.75	Facility		$150.63	$150.75	$150.75
BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.27 / $150.75 / $188.44	Professional		$124.27	$150.75	$188.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $96.29 / $101.10 / $137.51	Facility		$96.29	$101.10	$137.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $150.63 / $187.69 / $239.95	Professional		$150.63	$187.69	$239.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.96 / $194.56 / $380.50	Professional		$118.96	$194.56	$380.50
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $105.14 / $143.72 / $210.00	Facility		$105.14	$143.72	$210.00
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $288.52 / $288.52 / $288.52	Facility	25	$288.52	$288.52	$288.52
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $123.82 / $185.28 / $288.72	Professional		$123.82	$185.28	$288.72
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $171.00 / $249.57 / $340.00	Professional	25	$171.00	$249.57	$340.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $161.00 / $201.77 / $283.72	Professional		$161.00	$201.77	$283.72
United Facility/Professional Professional Modifier Low / Median / High Price $143.00 / $190.06 / $262.52	Professional		$143.00	$190.06	$262.52