Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.54 / $106.05 / $214.97	Facility		$37.54	$106.05	$214.97
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.52 / $11.52 / $12.40	Facility	26	$11.52	$11.52	$12.40
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.00 / $39.00 / $272.95	Facility	TC	$26.00	$39.00	$272.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.73 / $37.53 / $87.55	Professional		$30.73	$37.53	$87.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $11.52 / $29.70	Professional	26	$9.27	$11.52	$29.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.60 / $26.00 / $45.35	Professional	TC	$20.60	$26.00	$45.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.66 / $27.34 / $36.93	Professional		$24.66	$27.34	$36.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.50 / $9.21 / $18.34	Professional	26	$7.50	$9.21	$18.34
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.56 / $22.56 / $22.56	Professional	TC	$22.56	$22.56	$22.56
BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.10 / $55.53 / $96.52	Facility		$40.10	$55.53	$96.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.73 / $41.83 / $59.16	Professional		$13.73	$41.83	$59.16
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.13 / $15.45 / $15.45	Professional	26	$13.13	$15.45	$15.45
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 $9.27 / $24.08 / $40.46	Facility		$9.27	$24.08	$40.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.36 / $26.87 / $41.95	Professional		$10.36	$26.87	$41.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $36.90 / $36.90 / $36.90	Facility		$36.90	$36.90	$36.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.16 / $11.16 / $11.16	Facility	26	$11.16	$11.16	$11.16
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 $27.54 / $41.88 / $70.65	Professional		$27.54	$41.88	$70.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.86 / $12.83 / $23.87	Professional	26	$7.86	$12.83	$23.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.19 / $30.05 / $52.80	Professional	TC	$18.19	$30.05	$52.80
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $37.53 / $133.94 / $264.48	Facility		$37.53	$133.94	$264.48
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.66 / $11.52 / $12.10	Facility	26	$8.66	$11.52	$12.10
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $26.00 / $48.10 / $244.57	Facility	TC	$26.00	$48.10	$244.57
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $27.13 / $37.53 / $69.48	Professional		$27.13	$37.53	$69.48
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $11.52 / $28.51	Professional	26	$8.66	$11.52	$28.51
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.47 / $26.00 / $43.69	Professional	TC	$18.47	$26.00	$43.69
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 Professional Modifier Low / Median / High Price $29.57 / $35.17 / $50.70	Professional		$29.57	$35.17	$50.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $11.69 / $17.17	Professional	26	$9.65	$11.69	$17.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.11 / $23.33 / $34.90	Professional	TC	$19.11	$23.33	$34.90