Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $129.47 / $129.47 / $129.47	Facility		$129.47	$129.47	$129.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.35 / $129.47 / $129.47	Professional		$113.35	$129.47	$129.47
BCBS Facility/Professional Facility Modifier Low / Median / High Price $343.16 / $683.70 / $1,245.24	Facility		$343.16	$683.70	$1,245.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $215.38 / $226.72 / $306.07	Professional		$215.38	$226.72	$306.07
CareSource Facility/Professional Facility Modifier Low / Median / High Price $140.96 / $147.37 / $154.55	Facility		$140.96	$147.37	$154.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $181.38 / $181.38 / $181.38	Professional		$181.38	$181.38	$181.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $135.51 / $135.51 / $135.51	Facility		$135.51	$135.51	$135.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.51 / $135.51 / $262.88	Professional		$135.51	$135.51	$262.88
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $129.47 / $163.84 / $163.84	Facility		$129.47	$163.84	$163.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $129.47 / $163.84 / $255.02	Professional		$129.47	$163.84	$255.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $103.68	Professional		$30.00	$30.00	$103.68
United Facility/Professional Professional Modifier Low / Median / High Price $84.71 / $108.19 / $162.27	Professional		$84.71	$108.19	$162.27