Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.95 / $79.95 / $79.95	Facility		$79.95	$79.95	$79.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.53 / $79.95 / $79.95	Professional		$60.53	$79.95	$79.95
BCBS Facility/Professional Facility Modifier Low / Median / High Price $171.56 / $341.82 / $622.55	Facility		$171.56	$341.82	$622.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.68 / $113.35 / $153.02	Professional		$107.68	$113.35	$153.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $73.68 / $73.68 / $86.79	Facility		$73.68	$73.68	$86.79
CareSource Facility/Professional Professional Modifier Low / Median / High Price $90.68 / $90.68 / $90.68	Professional		$90.68	$90.68	$90.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.17 / $52.17 / $52.17	Facility		$52.17	$52.17	$52.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.17 / $52.17 / $177.30	Professional		$52.17	$52.17	$177.30
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $21.70 / $21.70 / $79.95	Facility		$21.70	$21.70	$79.95
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $21.70 / $79.95 / $136.02	Professional		$21.70	$79.95	$136.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $109.05 / $128.30 / $147.54	Professional		$109.05	$128.30	$147.54
United Facility/Professional Professional Modifier Low / Median / High Price $70.64 / $105.43 / $175.72	Professional		$70.64	$105.43	$175.72