Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $96.10 / $195.97 / $293.58	Facility		$96.10	$195.97	$293.58
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $155.44 / $155.44 / $155.44	Facility	25	$155.44	$155.44	$155.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $157.27 / $210.64 / $350.40	Professional		$157.27	$210.64	$350.40
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $210.64 / $294.05 / $410.12	Professional	25	$210.64	$294.05	$410.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $152.27 / $277.70 / $399.88	Professional		$152.27	$277.70	$399.88
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $235.14 / $235.14 / $235.14	Professional	25	$235.14	$235.14	$235.14
BCBS Facility/Professional Facility Modifier Low / Median / High Price $204.87 / $204.87 / $204.87	Facility		$204.87	$204.87	$204.87
BCBS Facility/Professional Professional Modifier Low / Median / High Price $184.38 / $204.87 / $256.08	Professional		$184.38	$204.87	$256.08
CareSource Facility/Professional Facility Modifier Low / Median / High Price $130.78 / $137.32 / $186.96	Facility		$130.78	$137.32	$186.96
CareSource Facility/Professional Professional Modifier Low / Median / High Price $204.24 / $254.34 / $325.33	Professional		$204.24	$254.34	$325.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.62 / $273.64 / $515.34	Professional		$161.62	$273.64	$515.34
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $96.10 / $195.97 / $279.60	Facility		$96.10	$195.97	$279.60
Health Alliance Plan Facility/Professional Facility Modifier 25 Low / Median / High Price $155.44 / $155.44 / $155.44	Facility	25	$155.44	$155.44	$155.44
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $176.28 / $236.81 / $382.80	Professional		$176.28	$236.81	$382.80
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $210.64 / $300.82 / $479.30	Professional	25	$210.64	$300.82	$479.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $214.67 / $269.03 / $378.30	Professional		$214.67	$269.03	$378.30
United Facility/Professional Professional Modifier Low / Median / High Price $234.78 / $268.08 / $355.12	Professional		$234.78	$268.08	$355.12