Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $88.67 / $88.67 / $88.67	Facility		$88.67	$88.67	$88.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.37 / $88.67 / $88.67	Professional		$76.37	$88.67	$88.67
BCBS Facility/Professional Facility Modifier Low / Median / High Price $234.99 / $468.20 / $852.75	Facility		$234.99	$468.20	$852.75
BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.50 / $155.26 / $209.60	Professional		$147.50	$155.26	$209.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $94.36 / $94.36 / $100.92	Facility		$94.36	$94.36	$100.92
CareSource Facility/Professional Professional Modifier Low / Median / High Price $124.21 / $124.21 / $124.21	Professional		$124.21	$124.21	$124.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.43 / $100.43 / $100.43	Facility		$100.43	$100.43	$100.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.43 / $100.43 / $180.00	Professional		$100.43	$100.43	$180.00
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $88.67 / $112.20 / $112.20	Facility		$88.67	$112.20	$112.20
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $87.19 / $112.20 / $163.02	Professional		$87.19	$112.20	$163.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $94.20 / $114.89 / $132.12	Professional		$94.20	$114.89	$132.12
United Facility/Professional Professional Modifier Low / Median / High Price $56.71 / $72.91 / $111.12	Professional		$56.71	$72.91	$111.12