Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $106.97 / $106.97 / $106.97	Facility		$106.97	$106.97	$106.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.23 / $106.97 / $106.97	Professional		$75.23	$106.97	$106.97
BCBS Facility/Professional Facility Modifier Low / Median / High Price $283.51 / $564.85 / $1,028.78	Facility		$283.51	$564.85	$1,028.78
BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.94 / $187.31 / $252.87	Professional		$177.94	$187.31	$252.87
CareSource Facility/Professional Facility Modifier Low / Median / High Price $92.98 / $120.82 / $121.75	Facility		$92.98	$120.82	$121.75
CareSource Facility/Professional Professional Modifier Low / Median / High Price $149.85 / $149.85 / $149.85	Professional		$149.85	$149.85	$149.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.11 / $89.11 / $89.11	Facility		$89.11	$89.11	$89.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.11 / $89.11 / $217.13	Professional		$89.11	$89.11	$217.13
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $106.97 / $135.36 / $135.36	Facility		$106.97	$135.36	$135.36
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $106.97 / $135.36 / $210.68	Professional		$106.97	$135.36	$210.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $62.73	Professional		$30.00	$30.00	$62.73
United Facility/Professional Professional Modifier Low / Median / High Price $58.41 / $87.96 / $134.06	Professional		$58.41	$87.96	$134.06