Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.50 / $52.50 / $52.50	Facility		$52.50	$52.50	$52.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.62 / $52.50 / $52.50	Professional		$43.62	$52.50	$52.50
BCBS Facility/Professional Facility Modifier Low / Median / High Price $139.13 / $277.22 / $504.92	Facility		$139.13	$277.22	$504.92
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.33 / $91.93 / $124.11	Professional		$87.33	$91.93	$124.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $58.34 / $59.75 / $60.10	Facility		$58.34	$59.75	$60.10
CareSource Facility/Professional Professional Modifier Low / Median / High Price $73.54 / $73.54 / $73.54	Professional		$73.54	$73.54	$73.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.32 / $51.32 / $51.32	Facility		$51.32	$51.32	$51.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.32 / $51.32 / $106.50	Professional		$51.32	$51.32	$106.50
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $52.50 / $66.43 / $66.43	Facility		$52.50	$66.43	$66.43
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $50.88 / $66.43 / $96.52	Professional		$50.88	$66.43	$96.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $55.78 / $68.03 / $78.23	Professional		$55.78	$68.03	$78.23
United Facility/Professional Professional Modifier Low / Median / High Price $34.15 / $43.17 / $65.79	Professional		$34.15	$43.17	$65.79