Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,733.64 / $1,733.64 / $2,737.32	Facility		$1,733.64	$1,733.64	$2,737.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,075.00 / $1,733.64 / $2,167.05	Professional		$1,075.00	$1,733.64	$2,167.05
BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,731.04 / $3,808.21 / $6,688.47	Facility		$2,731.04	$3,808.21	$6,688.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,398.75 / $2,525.00 / $2,701.75	Professional		$2,398.75	$2,525.00	$2,701.75
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,824.88 / $2,189.86 / $4,379.71	Facility		$1,824.88	$2,189.86	$4,379.71
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,824.88 / $2,281.10 / $2,463.59	Professional		$1,824.88	$2,281.10	$2,463.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $924.77 / $1,208.27 / $2,539.07	Professional		$924.77	$1,208.27	$2,539.07
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $1,637.28 / $1,733.64 / $3,185.56	Facility		$1,637.28	$1,733.64	$3,185.56
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $1,733.64 / $2,338.69 / $2,485.86	Professional		$1,733.64	$2,338.69	$2,485.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,511.00 / $1,662.10 / $2,719.80	Professional		$1,511.00	$1,662.10	$2,719.80
United Facility/Professional Facility Modifier Low / Median / High Price $1,824.88 / $1,824.88 / $1,824.88	Facility		$1,824.88	$1,824.88	$1,824.88
United Facility/Professional Professional Modifier Low / Median / High Price $766.45 / $1,094.93 / $2,372.34	Professional		$766.45	$1,094.93	$2,372.34