Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.00 / $25.00 / $25.00	Facility		$25.00	$25.00	$25.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $25.00 / $25.00	Professional		$25.00	$25.00	$25.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.09 / $32.72 / $44.19	Professional		$31.09	$32.72	$44.19
CareSource Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $250.00 / $250.00	Facility		$250.00	$250.00	$250.00
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.00 / $22.03 / $76.56	Professional		$15.00	$22.03	$76.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.29 / $96.29 / $120.36	Professional		$96.29	$96.29	$120.36
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $25.00 / $25.00	Professional		$25.00	$25.00	$25.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $1,500.00	Professional		$30.00	$30.00	$1,500.00