Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.73 / $201.16 / $253.46	Facility		$52.73	$201.16	$253.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $167.09 / $201.16 / $201.16	Professional		$167.09	$201.16	$201.16
BCBS Facility/Professional Facility Modifier Low / Median / High Price $533.14 / $1,062.21 / $1,934.64	Facility		$533.14	$1,062.21	$1,934.64
BCBS Facility/Professional Professional Modifier Low / Median / High Price $334.63 / $352.24 / $475.52	Professional		$334.63	$352.24	$475.52
CareSource Facility/Professional Facility Modifier Low / Median / High Price $223.46 / $228.96 / $230.17	Facility		$223.46	$228.96	$230.17
CareSource Facility/Professional Professional Modifier Low / Median / High Price $281.79 / $281.79 / $281.79	Professional		$281.79	$281.79	$281.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $212.98 / $212.98 / $212.98	Facility		$212.98	$212.98	$212.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $212.98 / $212.98 / $408.38	Professional		$212.98	$212.98	$408.38
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $52.73 / $253.46 / $254.52	Facility		$52.73	$253.46	$254.52
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $201.16 / $254.52 / $422.68	Professional		$201.16	$254.52	$422.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Professional		$30.00	$30.00	$30.00
United Facility/Professional Professional Modifier Low / Median / High Price $122.90 / $165.40 / $248.95	Professional		$122.90	$165.40	$248.95