Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Facility		$30.00	$30.00	$30.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Professional		$30.00	$30.00	$30.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $28.08 / $28.08 / $30.71	Facility		$28.08	$28.08	$30.71
CareSource Facility/Professional Professional Modifier Low / Median / High Price $60.02 / $60.02 / $60.02	Professional		$60.02	$60.02	$60.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.32 / $38.13 / $38.13	Professional		$19.32	$38.13	$38.13
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Facility		$30.00	$30.00	$30.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Professional		$30.00	$30.00	$30.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $55.00	Professional		$30.00	$30.00	$55.00
United Facility/Professional Professional Modifier Low / Median / High Price $188.65 / $188.65 / $188.65	Professional		$188.65	$188.65	$188.65