Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $29.68 / $86.27 / $262.41	Facility		$29.68	$86.27	$262.41
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.34 / $10.34 / $10.86	Facility	26	$10.34	$10.34	$10.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.32 / $177.20 / $204.97	Facility	TC	$19.32	$177.20	$204.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $27.47 / $64.40	Professional		$17.78	$27.47	$64.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $11.06 / $39.06	Professional	26	$8.11	$11.06	$39.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.74 / $18.52 / $29.88	Professional	TC	$9.74	$18.52	$29.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.12 / $21.63 / $25.45	Professional		$20.12	$21.63	$25.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.58 / $8.64 / $14.50	Professional	26	$6.58	$8.64	$14.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.82 / $16.82 / $16.82	Professional	TC	$16.82	$16.82	$16.82
BCBS Facility/Professional Facility Modifier Low / Median / High Price $29.01 / $41.26 / $73.37	Facility		$29.01	$41.26	$73.37
BCBS Facility/Professional Professional Modifier Low / Median / High Price $14.25 / $32.04 / $44.67	Professional		$14.25	$32.04	$44.67
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $13.85 / $13.85	Professional	26	$11.77	$13.85	$13.85
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.55 / $27.70 / $27.70	Professional	TC	$23.55	$27.70	$27.70
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.31 / $18.43 / $32.02	Facility		$8.31	$18.43	$32.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.27 / $19.97 / $33.04	Professional		$9.27	$19.97	$33.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.01 / $29.01 / $29.01	Facility		$29.01	$29.01	$29.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.67 / $9.67 / $9.67	Facility	26	$9.67	$9.67	$9.67
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $19.39 / $19.39 / $19.39	Facility	TC	$19.39	$19.39	$19.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.51 / $26.81 / $55.66	Professional		$19.51	$26.81	$55.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.10 / $21.44	Professional	26	$7.08	$11.10	$21.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.54 / $16.12 / $36.50	Professional	TC	$10.54	$16.12	$36.50
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $30.42 / $98.58 / $267.30	Facility		$30.42	$98.58	$267.30
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $7.14 / $10.34 / $10.61	Facility	26	$7.14	$10.34	$10.61
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $19.32 / $45.67 / $203.62	Facility	TC	$19.32	$45.67	$203.62
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $15.28 / $29.67 / $48.00	Professional		$15.28	$29.67	$48.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.35 / $39.06	Professional	26	$7.94	$10.35	$39.06
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $8.14 / $19.32 / $29.00	Professional	TC	$8.14	$19.32	$29.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $32.80 / $45.08	Professional		$26.17	$32.80	$45.08
United Facility/Professional Facility Modifier Low / Median / High Price $80.90 / $80.90 / $80.90	Facility		$80.90	$80.90	$80.90
United Facility/Professional Professional Modifier Low / Median / High Price $19.55 / $24.68 / $86.60	Professional		$19.55	$24.68	$86.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.16 / $10.00 / $15.06	Professional	26	$8.16	$10.00	$15.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.42 / $14.00 / $20.77	Professional	TC	$10.42	$14.00	$20.77