Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $4.54 / $4.54 / $4.54	Facility		$4.54	$4.54	$4.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $4.54 / $4.54 / $6.09	Professional		$4.54	$4.54	$6.09
BCBS Facility/Professional Facility Modifier Low / Median / High Price $75.68 / $152.12 / $274.62	Facility		$75.68	$152.12	$274.62
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.50 / $50.00 / $67.50	Professional		$47.50	$50.00	$67.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $84.34 / $84.34 / $140.26	Facility		$84.34	$84.34	$140.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $9.27 / $9.27 / $9.27	Facility		$9.27	$9.27	$9.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $9.27 / $9.27 / $13.13	Professional		$9.27	$9.27	$13.13
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $4.54 / $9.17 / $9.17	Facility		$4.54	$9.17	$9.17
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $4.54 / $9.17 / $10.08	Professional		$4.54	$9.17	$10.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $50.00	Professional		$30.00	$30.00	$50.00
United Facility/Professional Professional Modifier Low / Median / High Price $4.32 / $6.02 / $11.01	Professional		$4.32	$6.02	$11.01