Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.75 / $149.75 / $149.75	Facility		$149.75	$149.75	$149.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.04 / $149.75 / $157.97	Professional		$128.04	$149.75	$157.97
BCBS Facility/Professional Facility Modifier Low / Median / High Price $396.90 / $790.78 / $1,440.27	Facility		$396.90	$790.78	$1,440.27
BCBS Facility/Professional Professional Modifier Low / Median / High Price $249.12 / $262.23 / $354.01	Professional		$249.12	$262.23	$354.01
CareSource Facility/Professional Facility Modifier Low / Median / High Price $158.44 / $170.45 / $171.27	Facility		$158.44	$170.45	$171.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $209.78 / $209.78 / $209.78	Professional		$209.78	$209.78	$209.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $184.91 / $184.91 / $184.91	Facility		$184.91	$184.91	$184.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $184.91 / $184.91 / $304.13	Professional		$184.91	$184.91	$304.13
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $149.75 / $189.49 / $189.49	Facility		$149.75	$189.49	$189.49
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $149.75 / $189.49 / $275.33	Professional		$149.75	$189.49	$275.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $159.12 / $194.05 / $223.15	Professional		$159.12	$194.05	$223.15
United Facility/Professional Professional Modifier Low / Median / High Price $101.34 / $125.36 / $187.40	Professional		$101.34	$125.36	$187.40