Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.38 / $120.01 / $305.37	Facility		$45.38	$120.01	$305.37
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.72 / $12.72 / $16.02	Facility	26	$12.72	$12.72	$16.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.67 / $154.32 / $295.32	Facility	TC	$32.67	$154.32	$295.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $46.83 / $114.09	Professional		$36.65	$46.83	$114.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $12.72 / $48.26	Professional	26	$10.02	$12.72	$48.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $32.67 / $58.15	Professional	TC	$26.62	$32.67	$58.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.85 / $32.92 / $48.19	Professional		$27.85	$32.92	$48.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.08 / $12.67 / $20.30	Professional	26	$8.08	$12.67	$20.30
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 $48.30 / $69.03 / $119.97	Facility		$48.30	$69.03	$119.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.12 / $48.19 / $65.19	Professional		$19.12	$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 $44.74 / $44.74 / $44.74	Facility		$44.74	$44.74	$44.74
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 $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.84 / $45.86 / $84.93	Professional		$30.84	$45.86	$84.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $13.53 / $26.30	Professional	26	$8.64	$13.53	$26.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.51 / $33.01 / $61.29	Professional	TC	$21.51	$33.01	$61.29
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $45.38 / $143.07 / $332.50	Facility		$45.38	$143.07	$332.50
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $12.72 / $16.02	Facility	26	$9.61	$12.72	$16.02
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $32.67 / $77.18 / $295.32	Facility	TC	$32.67	$77.18	$295.32
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $30.19 / $45.38 / $94.54	Professional		$30.19	$45.38	$94.54
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.61 / $12.72 / $33.97	Professional	26	$9.61	$12.72	$33.97
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.58 / $32.67 / $55.57	Professional	TC	$20.58	$32.67	$55.57
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 $33.20 / $39.81 / $55.89	Professional		$33.20	$39.81	$55.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.13 / $12.56 / $18.51	Professional	26	$10.13	$12.56	$18.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.01 / $27.40 / $40.69	Professional	TC	$23.01	$27.40	$40.69