Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,242.19 / $1,242.19 / $1,242.19	Facility		$1,242.19	$1,242.19	$1,242.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,031.83 / $1,242.19 / $1,242.19	Professional		$1,031.83	$1,242.19	$1,242.19
BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,292.19 / $6,559.32 / $11,946.68	Facility		$3,292.19	$6,559.32	$11,946.68
BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,066.37 / $2,175.13 / $2,936.43	Professional		$2,066.37	$2,175.13	$2,936.43
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,379.95 / $1,413.83 / $1,421.50	Facility		$1,379.95	$1,413.83	$1,421.50
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,740.10 / $1,740.10 / $1,740.10	Professional		$1,740.10	$1,740.10	$1,740.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,407.05 / $1,407.05 / $1,407.05	Facility		$1,407.05	$1,407.05	$1,407.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,027.15 / $1,453.35 / $2,798.87	Professional		$1,027.15	$1,453.35	$2,798.87
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $1,242.19 / $1,571.84 / $1,571.84	Facility		$1,242.19	$1,571.84	$1,571.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $1,242.19 / $1,571.84 / $2,446.46	Professional		$1,242.19	$1,571.84	$2,446.46
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 $759.03 / $1,021.45 / $1,615.66	Professional		$759.03	$1,021.45	$1,615.66