Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.00 / $104.40 / $301.97	Facility		$39.00	$104.40	$301.97
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.34 / $12.34 / $35.68	Facility	26	$12.34	$12.34	$35.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.00 / $180.26 / $227.14	Facility	TC	$26.00	$180.26	$227.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.66 / $38.69 / $119.28	Professional		$27.66	$38.69	$119.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.85 / $14.48 / $58.00	Professional	26	$9.85	$14.48	$58.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.25 / $26.00 / $43.69	Professional	TC	$18.25	$26.00	$43.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.83 / $30.57 / $41.37	Professional		$23.83	$30.57	$41.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.02 / $13.31 / $15.50	Professional	26	$8.02	$13.31	$15.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.56 / $22.56 / $37.28	Professional	TC	$22.56	$22.56	$37.28
BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.04 / $55.53 / $96.52	Facility		$39.04	$55.53	$96.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $15.44 / $40.22 / $67.89	Professional		$15.44	$40.22	$67.89
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.03 / $16.51 / $16.51	Professional	26	$14.03	$16.51	$16.51
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.69 / $37.28 / $37.28	Professional	TC	$31.69	$37.28	$37.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.92 / $24.31 / $41.37	Facility		$9.92	$24.31	$41.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.11 / $26.87 / $42.85	Professional		$11.11	$26.87	$42.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $37.65 / $37.65 / $37.65	Facility		$37.65	$37.65	$37.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $26.10 / $26.10	Facility	TC	$26.10	$26.10	$26.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.80 / $39.04 / $72.19	Professional		$25.80	$39.04	$72.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.35 / $13.25 / $25.56	Professional	26	$8.35	$13.25	$25.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.82 / $25.67 / $49.25	Professional	TC	$17.82	$25.67	$49.25
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $39.29 / $134.68 / $300.89	Facility		$39.29	$134.68	$300.89
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.47 / $12.34 / $15.56	Facility	26	$8.47	$12.34	$15.56
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $26.00 / $81.12 / $227.14	Facility	TC	$26.00	$81.12	$227.14
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $23.25 / $38.35 / $96.30	Professional		$23.25	$38.35	$96.30
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $12.35 / $45.90	Professional	26	$9.66	$12.35	$45.90
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $14.77 / $26.00 / $43.00	Professional	TC	$14.77	$26.00	$43.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $33.09 / $47.38	Professional		$26.31	$33.09	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $27.92 / $32.29 / $47.97	Professional		$27.92	$32.29	$47.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.07 / $12.31 / $59.93	Professional	26	$10.07	$12.31	$59.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.71 / $21.50 / $84.91	Professional	TC	$18.71	$21.50	$84.91