Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $247.46 / $1,135.13 / $4,933.00	Facility		$247.46	$1,135.13	$4,933.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.67 / $50.67 / $63.84	Facility	26	$50.67	$50.67	$63.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.13 / $221.87 / $290.95	Professional		$140.13	$221.87	$290.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.10 / $50.67 / $121.62	Professional	26	$40.10	$50.67	$121.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.17 / $150.08 / $220.72	Professional	TC	$94.17	$150.08	$220.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $270.70 / $270.70 / $270.70	Professional		$270.70	$270.70	$270.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.40 / $39.40 / $39.40	Professional	26	$39.40	$39.40	$39.40
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,111.83 / $1,511.85 / $3,550.38	Facility		$1,111.83	$1,511.85	$3,550.38
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.59 / $172.40 / $265.23	Professional		$50.59	$172.40	$265.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.96 / $62.31 / $62.31	Professional	26	$52.96	$62.31	$62.31
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $172.48 / $202.92 / $202.92	Professional	TC	$172.48	$202.92	$202.92
CareSource Facility/Professional Facility Modifier Low / Median / High Price $37.06 / $149.33 / $209.06	Facility		$37.06	$149.33	$209.06
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.72 / $142.04 / $194.42	Professional		$37.72	$142.04	$194.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.99 / $229.24 / $403.99	Professional		$130.99	$229.24	$403.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $53.51 / $88.95	Professional	26	$36.72	$53.51	$88.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.79 / $154.08 / $227.86	Professional	TC	$102.79	$154.08	$227.86
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $120.31 / $1,140.75 / $4,933.00	Facility		$120.31	$1,140.75	$4,933.00
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $40.19 / $40.19 / $63.84	Facility	26	$40.19	$40.19	$63.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $120.31 / $201.76 / $308.89	Professional		$120.31	$201.76	$308.89
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $40.19 / $50.67 / $120.92	Professional	26	$40.19	$50.67	$120.92
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $80.12 / $145.81 / $233.11	Professional	TC	$80.12	$145.81	$233.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.11 / $145.31 / $216.42	Professional		$37.11	$145.31	$216.42
United Facility/Professional Facility Modifier Low / Median / High Price $464.00 / $1,428.00 / $2,029.00	Facility		$464.00	$1,428.00	$2,029.00
United Facility/Professional Professional Modifier Low / Median / High Price $133.91 / $204.83 / $330.41	Professional		$133.91	$204.83	$330.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.69 / $56.34 / $93.99	Professional	26	$45.69	$56.34	$93.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.28 / $140.69 / $262.24	Professional	TC	$88.28	$140.69	$262.24