Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $27.60 / $27.87 / $39.00	Facility		$27.60	$27.87	$39.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.91 / $33.19 / $62.04	Professional		$23.91	$33.19	$62.04
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $41.27 / $144.00 / $172.00	Professional	25	$41.27	$144.00	$172.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.96 / $15.11 / $19.80	Professional	52	$11.96	$15.11	$19.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.84 / $38.97 / $44.10	Professional		$30.84	$38.97	$44.10
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $35.18 / $48.73 / $48.73	Professional	25	$35.18	$48.73	$48.73
BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.34 / $40.34 / $288.57	Facility		$40.34	$40.34	$288.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.32 / $42.36 / $50.43	Professional		$38.32	$42.36	$50.43
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.40 / $31.77 / $38.27	Facility		$25.40	$31.77	$38.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.94 / $46.81 / $59.30	Professional		$36.94	$46.81	$59.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.82 / $34.82 / $54.77	Professional		$34.82	$34.82	$54.77
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $27.60 / $36.74 / $47.89	Facility		$27.60	$36.74	$47.89
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $27.60 / $38.63 / $62.05	Professional		$27.60	$38.63	$62.05
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $172.00 / $172.00 / $172.00	Professional	25	$172.00	$172.00	$172.00
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $12.71 / $15.92 / $21.47	Professional	52	$12.71	$15.92	$21.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $33.44 / $48.25	Professional		$26.52	$33.44	$48.25
United Facility/Professional Professional Modifier Low / Median / High Price $31.94 / $41.27 / $60.10	Professional		$31.94	$41.27	$60.10