Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.00 / $119.96 / $296.95	Facility		$45.00	$119.96	$296.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.72 / $12.72 / $13.72	Facility	26	$12.72	$12.72	$13.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.29 / $48.45 / $203.62	Facility	TC	$32.29	$48.45	$203.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.10 / $45.01 / $95.00	Professional		$35.10	$45.01	$95.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $12.72 / $48.00	Professional	26	$10.02	$12.72	$48.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.05 / $32.29 / $54.28	Professional	TC	$25.05	$32.29	$54.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.56 / $35.86 / $44.34	Professional		$29.56	$35.86	$44.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.97 / $11.48 / $16.73	Professional	26	$7.97	$11.48	$16.73
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.98 / $27.98 / $39.35	Professional	TC	$27.98	$27.98	$39.35
BCBS Facility/Professional Facility Modifier Low / Median / High Price $48.54 / $69.03 / $119.97	Facility		$48.54	$69.03	$119.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.73 / $48.19 / $65.19	Professional		$16.73	$48.19	$65.19
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.48 / $17.04 / $17.04	Professional	26	$14.48	$17.04	$17.04
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.39 / $46.34 / $46.34	Professional	TC	$39.39	$46.34	$46.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.23 / $29.92 / $48.52	Facility		$10.23	$29.92	$48.52
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.45 / $33.38 / $50.42	Professional		$11.45	$33.38	$50.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $44.36 / $44.36 / $44.36	Facility		$44.36	$44.36	$44.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.95 / $44.23 / $84.93	Professional		$29.95	$44.23	$84.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $13.58 / $26.30	Professional	26	$8.64	$13.58	$26.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.85 / $32.47 / $61.29	Professional	TC	$19.85	$32.47	$61.29
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $45.00 / $138.25 / $321.20	Facility		$45.00	$138.25	$321.20
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $12.72 / $13.35	Facility	26	$9.61	$12.72	$13.35
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $32.29 / $58.63 / $223.84	Facility	TC	$32.29	$58.63	$223.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $32.31 / $45.01 / $76.45	Professional		$32.31	$45.01	$76.45
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.61 / $12.72 / $30.91	Professional	26	$9.61	$12.72	$30.91
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $22.70 / $32.29 / $54.00	Professional	TC	$22.70	$32.29	$54.00
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 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 $32.33 / $38.34 / $53.77	Professional		$32.33	$38.34	$53.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.11 / $12.55 / $19.39	Professional	26	$10.11	$12.55	$19.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.01 / $26.57 / $37.04	Professional	TC	$23.01	$26.57	$37.04