Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.69 / $58.69 / $58.69	Facility		$58.69	$58.69	$58.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.80 / $58.69 / $63.76	Professional		$53.80	$58.69	$63.76
BCBS Facility/Professional Facility Modifier Low / Median / High Price $155.55 / $309.91 / $564.45	Facility		$155.55	$309.91	$564.45
BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.63 / $102.77 / $138.74	Professional		$97.63	$102.77	$138.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $66.80 / $68.28 / $75.95	Facility		$66.80	$68.28	$75.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $82.22 / $82.22 / $82.22	Professional		$82.22	$82.22	$82.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.48 / $61.48 / $61.48	Facility		$61.48	$61.48	$61.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.48 / $61.48 / $119.25	Professional		$61.48	$61.48	$119.25
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $58.69 / $74.27 / $74.27	Facility		$58.69	$74.27	$74.27
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $58.69 / $74.27 / $115.59	Professional		$58.69	$74.27	$115.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $35.28	Professional		$30.00	$30.00	$35.28
United Facility/Professional Facility Modifier Low / Median / High Price $29.60 / $29.60 / $29.60	Facility		$29.60	$29.60	$29.60
United Facility/Professional Professional Modifier Low / Median / High Price $38.43 / $49.09 / $73.56	Professional		$38.43	$49.09	$73.56