Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.17 / $126.81 / $249.21	Facility		$37.17	$126.81	$249.21
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.52 / $9.52 / $10.01	Facility	26	$9.52	$9.52	$10.01
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.10 / $28.46 / $177.20	Facility	TC	$27.10	$28.46	$177.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.46 / $36.65 / $74.61	Professional		$26.46	$36.65	$74.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.49 / $9.53 / $30.20	Professional	26	$7.49	$9.53	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $27.11 / $43.13	Professional	TC	$18.82	$27.11	$43.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.50 / $31.18 / $58.32	Professional		$26.50	$31.18	$58.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.86 / $7.66 / $14.64	Professional	26	$5.86	$7.66	$14.64
BCBS Facility/Professional Facility Modifier Low / Median / High Price $46.78 / $77.76 / $161.53	Facility		$46.78	$77.76	$161.53
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.92 / $51.13 / $105.17	Professional		$11.92	$51.13	$105.17
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $12.25 / $12.25	Professional	26	$10.41	$12.25	$12.25
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 $7.34 / $25.12 / $39.04	Facility		$7.34	$25.12	$39.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.19 / $27.79 / $40.54	Professional		$8.19	$27.79	$40.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.79 / $35.79 / $35.79	Facility		$35.79	$35.79	$35.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
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 $24.14 / $37.01 / $68.29	Professional		$24.14	$37.01	$68.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.30 / $10.03 / $19.75	Professional	26	$6.30	$10.03	$19.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.50 / $27.22 / $51.36	Professional	TC	$16.50	$27.22	$51.36
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $36.64 / $142.71 / $255.36	Facility		$36.64	$142.71	$255.36
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.82 / $9.52 / $10.01	Facility	26	$6.82	$9.52	$10.01
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $27.10 / $35.78 / $188.16	Facility	TC	$27.10	$35.78	$188.16
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $23.69 / $36.65 / $67.00	Professional		$23.69	$36.65	$67.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.82 / $9.52 / $23.85	Professional	26	$6.82	$9.52	$23.85
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.88 / $27.10 / $43.13	Professional	TC	$16.88	$27.10	$43.13
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 $26.81 / $31.72 / $45.61	Professional		$26.81	$31.72	$45.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.62 / $9.19 / $13.88	Professional	26	$7.62	$9.19	$13.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.91 / $22.05 / $31.63	Professional	TC	$18.91	$22.05	$31.63