Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.04 / $93.56 / $256.93	Facility		$37.04	$93.56	$256.93
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.93 / $9.93 / $10.43	Facility	26	$9.93	$9.93	$10.43
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.10 / $27.11 / $203.62	Facility	TC	$27.10	$27.11	$203.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.46 / $37.04 / $58.43	Professional		$26.46	$37.04	$58.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $9.93 / $26.00	Professional	26	$7.33	$9.93	$26.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $27.11 / $41.48	Professional	TC	$19.14	$27.11	$41.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.35 / $25.11 / $31.82	Professional		$21.35	$25.11	$31.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.66 / $8.94 / $11.91	Professional	26	$6.66	$8.94	$11.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.52 / $23.52 / $33.04	Professional	TC	$23.52	$23.52	$33.04
BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.72 / $57.92 / $100.66	Facility		$40.72	$57.92	$100.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.07 / $41.48 / $58.56	Professional		$13.07	$41.48	$58.56
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.32 / $13.32 / $13.32	Professional	26	$13.32	$13.32	$13.32
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $38.88 / $38.88	Professional	TC	$33.04	$38.88	$38.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.98 / $25.12 / $39.90	Facility		$7.98	$25.12	$39.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.90 / $28.02 / $41.41	Professional		$8.90	$28.02	$41.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $36.53 / $36.53 / $36.53	Facility		$36.53	$36.53	$36.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $27.22 / $27.22 / $27.22	Facility	TC	$27.22	$27.22	$27.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.20 / $37.69 / $69.76	Professional		$25.20	$37.69	$69.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $10.60 / $20.59	Professional	26	$6.55	$10.60	$20.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.53 / $27.11 / $51.36	Professional	TC	$17.53	$27.11	$51.36
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $37.04 / $141.55 / $256.93	Facility		$37.04	$141.55	$256.93
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.82 / $9.93 / $10.43	Facility	26	$6.82	$9.93	$10.43
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $27.10 / $34.15 / $188.16	Facility	TC	$27.10	$34.15	$188.16
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $23.43 / $37.04 / $58.43	Professional		$23.43	$37.04	$58.43
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.82 / $9.93 / $18.19	Professional	26	$6.82	$9.93	$18.19
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.61 / $27.10 / $41.04	Professional	TC	$16.61	$27.10	$41.04
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 $27.13 / $31.49 / $45.61	Professional		$27.13	$31.49	$45.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.60 / $9.36 / $14.47	Professional	26	$7.60	$9.36	$14.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.23 / $21.86 / $31.09	Professional	TC	$19.23	$21.86	$31.09