Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $174.36 / $174.36 / $174.36	Facility		$174.36	$174.36	$174.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.34 / $174.36 / $236.02	Professional		$133.34	$174.36	$236.02
BCBS Facility/Professional Facility Modifier Low / Median / High Price $377.95 / $753.03 / $1,371.51	Facility		$377.95	$753.03	$1,371.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $237.22 / $249.71 / $337.11	Professional		$237.22	$249.71	$337.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $162.31 / $162.31 / $191.20	Facility		$162.31	$162.31	$191.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $199.77 / $199.77 / $199.77	Professional		$199.77	$199.77	$199.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $312.30 / $312.30 / $312.30	Facility		$312.30	$312.30	$312.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $312.30 / $312.30 / $380.10	Professional		$312.30	$312.30	$380.10
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $174.36 / $312.67 / $312.67	Facility		$174.36	$312.67	$312.67
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $174.36 / $265.76 / $343.93	Professional		$174.36	$265.76	$343.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $236.27 / $277.97 / $319.66	Professional		$236.27	$277.97	$319.66
United Facility/Professional Professional Modifier Low / Median / High Price $148.24 / $214.67 / $357.78	Professional		$148.24	$214.67	$357.78