Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.15 / $53.15 / $53.15	Facility		$53.15	$53.15	$53.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.13 / $53.15 / $53.15	Professional		$46.13	$53.15	$53.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.06 / $93.06 / $93.06	Professional		$93.06	$93.06	$93.06
BCBS Facility/Professional Facility Modifier Low / Median / High Price $140.85 / $280.63 / $511.12	Facility		$140.85	$280.63	$511.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.41 / $93.06 / $125.63	Professional		$88.41	$93.06	$125.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $59.05 / $60.49 / $60.83	Facility		$59.05	$60.49	$60.83
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.45 / $74.45 / $74.45	Professional		$74.45	$74.45	$74.45
Cigna Facility/Professional Facility Modifier Low / Median / High Price $56.56 / $56.56 / $64.81	Facility		$56.56	$56.56	$64.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.56 / $56.56 / $108.00	Professional		$56.56	$56.56	$108.00
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $53.15 / $67.27 / $67.27	Facility		$53.15	$67.27	$67.27
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $49.85 / $67.27 / $97.71	Professional		$49.85	$67.27	$97.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $56.46 / $68.86 / $79.18	Professional		$56.46	$68.86	$79.18
United Facility/Professional Professional Modifier Low / Median / High Price $34.51 / $43.71 / $66.62	Professional		$34.51	$43.71	$66.62