Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $163.63 / $165.24 / $165.24	Facility		$163.63	$165.24	$165.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.37 / $163.63 / $267.66	Professional		$136.37	$163.63	$267.66
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $115.53 / $115.53 / $260.77	Professional	25	$115.53	$115.53	$260.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.90 / $163.41 / $163.41	Professional		$138.90	$163.41	$163.41
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $157.90 / $158.59 / $298.70	Professional	25	$157.90	$158.59	$298.70
BCBS Facility/Professional Facility Modifier Low / Median / High Price $247.00 / $247.00 / $247.00	Facility		$247.00	$247.00	$247.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.65 / $259.35 / $308.75	Professional		$234.65	$259.35	$308.75
CareSource Facility/Professional Facility Modifier Low / Median / High Price $154.28 / $196.61 / $233.29	Facility		$154.28	$196.61	$233.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $159.83 / $200.56 / $254.09	Professional		$159.83	$200.56	$254.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.60 / $147.60 / $233.84	Professional		$147.60	$147.60	$233.84
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $163.01 / $163.62 / $214.61	Facility		$163.01	$163.62	$214.61
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $143.59 / $165.24 / $264.25	Professional		$143.59	$165.24	$264.25
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $115.53 / $115.53 / $172.15	Professional	25	$115.53	$115.53	$172.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $136.75 / $168.88 / $241.67	Professional		$136.75	$168.88	$241.67
United Facility/Professional Professional Modifier Low / Median / High Price $158.07 / $190.16 / $259.31	Professional		$158.07	$190.16	$259.31