Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $150.85 / $150.85 / $150.85	Facility		$150.85	$150.85	$150.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.24 / $150.85 / $150.85	Professional		$99.24	$150.85	$150.85
BCBS Facility/Professional Facility Modifier Low / Median / High Price $399.81 / $796.57 / $1,450.82	Facility		$399.81	$796.57	$1,450.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $250.94 / $264.14 / $356.60	Professional		$250.94	$264.14	$356.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $131.55 / $157.65 / $171.70	Facility		$131.55	$157.65	$171.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $211.32 / $211.32 / $211.32	Professional		$211.32	$211.32	$211.32
Cigna Facility/Professional Facility Modifier Low / Median / High Price $170.89 / $170.89 / $170.89	Facility		$170.89	$170.89	$170.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.89 / $170.89 / $306.38	Professional		$170.89	$170.89	$306.38
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $150.85 / $190.90 / $190.90	Facility		$150.85	$190.90	$190.90
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $149.47 / $190.90 / $277.35	Professional		$149.47	$190.90	$277.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $160.28 / $195.47 / $224.79	Professional		$160.28	$195.47	$224.79
United Facility/Professional Professional Modifier Low / Median / High Price $84.14 / $126.28 / $175.71	Professional		$84.14	$126.28	$175.71