Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.88 / $53.88 / $53.88	Facility		$53.88	$53.88	$53.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.83 / $53.88 / $53.88	Professional		$34.83	$53.88	$53.88
BCBS Facility/Professional Facility Modifier Low / Median / High Price $142.79 / $284.49 / $518.15	Facility		$142.79	$284.49	$518.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.62 / $94.34 / $127.36	Professional		$89.62	$94.34	$127.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $46.59 / $61.32 / $62.11	Facility		$46.59	$61.32	$62.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $75.47 / $75.47 / $75.47	Professional		$75.47	$75.47	$75.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.95 / $52.95 / $52.95	Facility		$52.95	$52.95	$52.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.95 / $52.95 / $109.50	Professional		$52.95	$52.95	$109.50
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $53.88 / $68.17 / $68.17	Facility		$53.88	$68.17	$68.17
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $49.69 / $68.17 / $99.05	Professional		$49.69	$68.17	$99.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.24 / $69.81 / $80.28	Professional		$57.24	$69.81	$80.28
United Facility/Professional Professional Modifier Low / Median / High Price $29.80 / $44.30 / $67.51	Professional		$29.80	$44.30	$67.51