Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.50 / $107.50 / $109.75	Facility		$107.50	$107.50	$109.75
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $113.00 / $113.00 / $113.00	Facility	25	$113.00	$113.00	$113.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.99 / $109.75 / $207.12	Professional		$85.99	$109.75	$207.12
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $37.39 / $119.40 / $207.12	Professional	25	$37.39	$119.40	$207.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.33 / $147.33 / $148.80	Professional		$147.33	$147.33	$148.80
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $151.88 / $178.68 / $207.68	Professional	25	$151.88	$178.68	$207.68
BCBS Facility/Professional Professional Modifier Low / Median / High Price $116.93 / $154.76 / $154.76	Professional		$116.93	$154.76	$154.76
CareSource Facility/Professional Facility Modifier Low / Median / High Price $118.71 / $162.43 / $202.93	Facility		$118.71	$162.43	$202.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $116.02 / $149.53 / $277.22	Professional		$116.02	$149.53	$277.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.91 / $116.36 / $116.36	Professional		$59.91	$116.36	$116.36
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $138.25 / $169.43 / $238.83	Professional		$138.25	$169.43	$238.83
Qualchoice Facility/Professional Professional Modifier 25 Low / Median / High Price $174.66 / $205.48 / $238.83	Professional	25	$174.66	$205.48	$238.83
United Facility/Professional Professional Modifier Low / Median / High Price $101.09 / $127.20 / $179.10	Professional		$101.09	$127.20	$179.10