Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.75 / $109.75 / $109.75	Facility		$109.75	$109.75	$109.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.11 / $109.75 / $109.75	Professional		$95.11	$109.75	$109.75
BCBS Facility/Professional Facility Modifier Low / Median / High Price $290.86 / $579.51 / $1,055.47	Facility		$290.86	$579.51	$1,055.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $182.56 / $192.17 / $259.43	Professional		$182.56	$192.17	$259.43
CareSource Facility/Professional Facility Modifier Low / Median / High Price $124.91 / $124.91 / $132.35	Facility		$124.91	$124.91	$132.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $153.74 / $153.74 / $153.74	Professional		$153.74	$153.74	$153.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $124.31 / $124.31 / $124.31	Facility		$124.31	$124.31	$124.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.75 / $159.79 / $278.44	Professional		$90.75	$159.79	$278.44
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $109.75 / $138.88 / $138.88	Facility		$109.75	$138.88	$138.88
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $109.75 / $138.88 / $201.77	Professional		$109.75	$138.88	$201.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $116.61 / $142.21 / $163.54	Professional		$116.61	$142.21	$163.54
United Facility/Professional Professional Modifier Low / Median / High Price $75.06 / $91.87 / $137.54	Professional		$75.06	$91.87	$137.54