Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $65.02 / $65.02 / $65.02	Facility		$65.02	$65.02	$65.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.18 / $65.02 / $65.02	Professional		$54.18	$65.02	$65.02
BCBS Facility/Professional Facility Modifier Low / Median / High Price $172.32 / $343.33 / $625.30	Facility		$172.32	$343.33	$625.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.16 / $113.85 / $153.69	Professional		$108.16	$113.85	$153.69
CareSource Facility/Professional Facility Modifier Low / Median / High Price $72.20 / $74.00 / $74.39	Facility		$72.20	$74.00	$74.39
CareSource Facility/Professional Professional Modifier Low / Median / High Price $91.08 / $91.08 / $91.08	Professional		$91.08	$91.08	$91.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $90.38 / $90.38 / $90.38	Facility		$90.38	$90.38	$90.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.38 / $90.38 / $132.00	Professional		$90.38	$90.38	$132.00
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $65.02 / $82.27 / $82.27	Facility		$65.02	$82.27	$82.27
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $65.02 / $82.27 / $128.05	Professional		$65.02	$82.27	$128.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Professional		$30.00	$30.00	$30.00
United Facility/Professional Professional Modifier Low / Median / High Price $42.28 / $54.43 / $81.48	Professional		$42.28	$54.43	$81.48