Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $115.47 / $115.47 / $115.47	Facility		$115.47	$115.47	$115.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.20 / $108.60 / $121.24	Professional		$100.20	$108.60	$121.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $202.19 / $202.19 / $202.19	Professional		$202.19	$202.19	$202.19
BCBS Facility/Professional Facility Modifier Low / Median / High Price $306.02 / $609.72 / $1,110.51	Facility		$306.02	$609.72	$1,110.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $192.08 / $202.19 / $272.95	Professional		$192.08	$202.19	$272.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $128.25 / $131.41 / $132.16	Facility		$128.25	$131.41	$132.16
CareSource Facility/Professional Professional Modifier Low / Median / High Price $161.75 / $161.75 / $161.75	Professional		$161.75	$161.75	$161.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $112.67 / $112.67 / $112.67	Facility		$112.67	$112.67	$112.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.67 / $112.67 / $234.38	Professional		$112.67	$112.67	$234.38
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $115.47 / $146.11 / $146.11	Facility		$115.47	$146.11	$146.11
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $108.29 / $146.11 / $216.60	Professional		$108.29	$146.11	$216.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $122.68 / $149.62 / $172.06	Professional		$122.68	$149.62	$172.06
United Facility/Professional Professional Modifier Low / Median / High Price $70.43 / $94.95 / $144.71	Professional		$70.43	$94.95	$144.71