Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $350.00 / $350.00 / $350.00	Facility		$350.00	$350.00	$350.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $350.00 / $350.00 / $350.00	Professional		$350.00	$350.00	$350.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $438.93 / $874.52 / $1,592.80	Facility		$438.93	$874.52	$1,592.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.50 / $290.00 / $391.50	Professional		$275.50	$290.00	$391.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $216.02 / $216.02 / $216.02	Facility		$216.02	$216.02	$216.02
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $350.00 / $350.00 / $350.00	Facility		$350.00	$350.00	$350.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $350.00 / $350.00 / $350.00	Professional		$350.00	$350.00	$350.00
United Facility/Professional Professional Modifier Low / Median / High Price $4,790.84 / $4,790.84 / $4,790.84	Professional		$4,790.84	$4,790.84	$4,790.84