Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $80.18 / $555.63 / $679.54	Facility		$80.18	$555.63	$679.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.19 / $47.19 / $49.54	Facility	26	$47.19	$47.19	$49.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.94 / $92.20 / $251.65	Professional		$42.94	$92.20	$251.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.18 / $56.14 / $89.47	Professional	26	$36.18	$56.14	$89.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.98 / $43.53 / $163.52	Professional	TC	$26.98	$43.53	$163.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.32 / $36.32 / $36.32	Professional		$36.32	$36.32	$36.32
BCBS Facility/Professional Facility Modifier Low / Median / High Price $52.65 / $72.34 / $182.74	Facility		$52.65	$72.34	$182.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $18.69 / $56.77 / $106.35	Professional		$18.69	$56.77	$106.35
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.34 / $49.34 / $58.05	Professional	26	$49.34	$49.34	$58.05
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.58 / $37.58 / $44.21	Professional	TC	$37.58	$37.58	$44.21
CareSource Facility/Professional Facility Modifier Low / Median / High Price $26.95 / $43.62 / $82.61	Facility		$26.95	$43.62	$82.61
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.30 / $44.88 / $80.54	Professional		$28.30	$44.88	$80.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.09 / $166.62 / $309.88	Professional		$71.09	$166.62	$309.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.79 / $80.56 / $157.71	Professional	26	$40.79	$80.56	$157.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.31 / $91.24 / $197.75	Professional	TC	$30.31	$91.24	$197.75
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $197.01 / $555.63 / $679.54	Facility		$197.01	$555.63	$679.54
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $47.19 / $77.29 / $77.29	Facility	26	$47.19	$77.29	$77.29
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $61.65 / $101.02 / $242.15	Professional		$61.65	$101.02	$242.15
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $36.60 / $56.62 / $98.94	Professional	26	$36.60	$56.62	$98.94
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.22 / $41.87 / $148.65	Professional	TC	$28.22	$41.87	$148.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.42 / $45.98 / $80.78	Professional		$28.42	$45.98	$80.78
United Facility/Professional Facility Modifier Low / Median / High Price $122.64 / $1,386.00 / $1,844.00	Facility		$122.64	$1,386.00	$1,844.00
United Facility/Professional Professional Modifier Low / Median / High Price $69.29 / $185.23 / $273.94	Professional		$69.29	$185.23	$273.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.70 / $79.27 / $108.50	Professional	26	$39.70	$79.27	$108.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.70 / $121.81 / $178.00	Professional	TC	$29.70	$121.81	$178.00