Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $84.75	Facility		$77.62	$77.62	$84.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.88 / $76.97 / $118.64	Professional		$39.88	$76.97	$118.64
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $62.94 / $77.51 / $134.32	Professional	25	$62.94	$77.51	$134.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.01 / $74.63 / $86.00	Professional		$66.01	$74.63	$86.00
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $71.09 / $97.02 / $106.76	Professional	25	$71.09	$97.02	$106.76
BCBS Facility/Professional Facility Modifier Low / Median / High Price $80.89 / $81.36 / $81.36	Facility		$80.89	$81.36	$81.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.84 / $84.61 / $101.70	Professional		$76.84	$84.61	$101.70
CareSource Facility/Professional Facility Modifier Low / Median / High Price $70.72 / $89.93 / $106.08	Facility		$70.72	$89.93	$106.08
CareSource Facility/Professional Professional Modifier Low / Median / High Price $79.53 / $100.36 / $158.22	Professional		$79.53	$100.36	$158.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.30 / $99.23 / $313.93	Professional		$65.30	$99.23	$313.93
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $12.35 / $14.20 / $84.75	Facility		$12.35	$14.20	$84.75
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $12.35 / $80.79 / $112.43	Professional		$12.35	$80.79	$112.43
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $60.49 / $77.51 / $127.45	Professional	25	$60.49	$77.51	$127.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.79 / $101.40 / $145.74	Professional		$81.79	$101.40	$145.74
United Facility/Professional Professional Modifier Low / Median / High Price $80.17 / $95.68 / $119.02	Professional		$80.17	$95.68	$119.02
United Facility/Professional Professional Modifier 25 Low / Median / High Price $99.10 / $99.10 / $99.10	Professional	25	$99.10	$99.10	$99.10