Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $242.26 / $242.26 / $242.26	Facility		$242.26	$242.26	$242.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.69 / $242.26 / $254.37	Professional		$204.69	$242.26	$254.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $424.21 / $424.21 / $424.21	Professional		$424.21	$424.21	$424.21
BCBS Facility/Professional Facility Modifier Low / Median / High Price $642.07 / $1,279.25 / $2,329.92	Facility		$642.07	$1,279.25	$2,329.92
BCBS Facility/Professional Professional Modifier Low / Median / High Price $403.00 / $424.21 / $572.67	Professional		$403.00	$424.21	$572.67
CareSource Facility/Professional Facility Modifier Low / Median / High Price $221.53 / $229.46 / $275.74	Facility		$221.53	$229.46	$275.74
CareSource Facility/Professional Professional Modifier Low / Median / High Price $339.37 / $339.37 / $339.37	Professional		$339.37	$339.37	$339.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $229.50 / $229.50 / $243.27	Facility		$229.50	$229.50	$243.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.50 / $229.50 / $491.63	Professional		$229.50	$229.50	$491.63
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $242.26 / $306.54 / $306.54	Facility		$242.26	$306.54	$306.54
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $212.96 / $306.54 / $445.42	Professional		$212.96	$306.54	$445.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $257.41 / $313.92 / $361.00	Professional		$257.41	$313.92	$361.00
United Facility/Professional Professional Modifier Low / Median / High Price $133.13 / $195.67 / $303.61	Professional		$133.13	$195.67	$303.61