Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $217.83 / $217.83 / $628.99	Facility		$217.83	$217.83	$628.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.25 / $217.83 / $247.18	Professional		$186.25	$217.83	$247.18
BCBS Facility/Professional Facility Modifier Low / Median / High Price $577.32 / $1,150.24 / $2,094.96	Facility		$577.32	$1,150.24	$2,094.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $362.36 / $381.43 / $514.92	Professional		$362.36	$381.43	$514.92
CareSource Facility/Professional Facility Modifier Low / Median / High Price $247.93 / $247.93 / $321.31	Facility		$247.93	$247.93	$321.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $305.14 / $305.14 / $305.14	Professional		$305.14	$305.14	$305.14
Cigna Facility/Professional Facility Modifier Low / Median / High Price $248.05 / $248.05 / $248.05	Facility		$248.05	$248.05	$248.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $248.05 / $248.05 / $442.13	Professional		$248.05	$248.05	$442.13
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $275.64 / $501.93 / $628.99	Facility		$275.64	$501.93	$628.99
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $217.83 / $275.64 / $400.50	Professional		$217.83	$275.64	$400.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $231.45 / $282.26 / $324.59	Professional		$231.45	$282.26	$324.59
United Facility/Professional Professional Modifier Low / Median / High Price $158.58 / $190.30 / $293.23	Professional		$158.58	$190.30	$293.23