Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.26 / $132.59 / $276.68	Facility		$95.26	$132.59	$276.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.18 / $126.92 / $191.85	Professional		$78.18	$126.92	$191.85
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $78.18 / $140.65 / $225.02	Professional	25	$78.18	$140.65	$225.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.26 / $128.84 / $142.37	Professional		$121.26	$128.84	$142.37
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $118.14 / $124.36 / $235.47	Professional	25	$118.14	$124.36	$235.47
BCBS Facility/Professional Facility Modifier Low / Median / High Price $194.71 / $194.71 / $194.71	Facility		$194.71	$194.71	$194.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $184.97 / $204.45 / $243.39	Professional		$184.97	$204.45	$243.39
CareSource Facility/Professional Facility Modifier Low / Median / High Price $121.26 / $154.32 / $183.90	Facility		$121.26	$154.32	$183.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $125.60 / $157.63 / $199.71	Professional		$125.60	$157.63	$199.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.36 / $116.36 / $184.31	Professional		$116.36	$116.36	$184.31
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $107.41 / $128.75 / $273.79	Facility		$107.41	$128.75	$273.79
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $97.00 / $127.51 / $186.43	Professional		$97.00	$127.51	$186.43
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $78.18 / $140.65 / $228.46	Professional	25	$78.18	$140.65	$228.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $109.20 / $135.72 / $192.51	Professional		$109.20	$135.72	$192.51
United Facility/Professional Professional Modifier Low / Median / High Price $105.56 / $127.51 / $169.20	Professional		$105.56	$127.51	$169.20