Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $575.28 / $575.28 / $575.28	Facility		$575.28	$575.28	$575.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $566.24 / $575.28 / $648.04	Professional		$566.24	$575.28	$648.04
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,764.81 / $3,516.19 / $6,404.14	Facility		$1,764.81	$3,516.19	$6,404.14
BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,107.70 / $1,166.00 / $1,574.10	Professional		$1,107.70	$1,166.00	$1,574.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $109.69 / $109.69 / $109.69	Facility		$109.69	$109.69	$109.69
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $575.28 / $575.28 / $575.28	Facility		$575.28	$575.28	$575.28
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $575.28 / $575.28 / $575.28	Professional		$575.28	$575.28	$575.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $55.00	Professional		$30.00	$30.00	$55.00