Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.16 / $120.60 / $285.12	Facility		$53.16	$120.60	$285.12
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.72 / $12.72 / $13.35	Facility	26	$12.72	$12.72	$13.35
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.45 / $126.20 / $274.68	Facility	TC	$40.45	$126.20	$274.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.25 / $53.82 / $138.69	Professional		$32.25	$53.82	$138.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $12.72 / $38.38	Professional	26	$10.02	$12.72	$38.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $40.45 / $68.61	Professional	TC	$27.55	$40.45	$68.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $42.94 / $53.02	Professional		$35.40	$42.94	$53.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.26 / $10.63 / $16.00	Professional	26	$8.26	$10.63	$16.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.64 / $35.64 / $35.64	Professional	TC	$35.64	$35.64	$35.64
BCBS Facility/Professional Facility Modifier Low / Median / High Price $61.92 / $88.07 / $153.06	Facility		$61.92	$88.07	$153.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $15.93 / $66.34 / $81.89	Professional		$15.93	$66.34	$81.89
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 $50.25 / $59.12 / $59.12	Professional	TC	$50.25	$59.12	$59.12
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.23 / $38.14 / $58.04	Facility		$10.23	$38.14	$58.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.45 / $41.46 / $60.52	Professional		$11.45	$41.46	$60.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.31 / $53.31 / $53.31	Facility		$53.31	$53.31	$53.31
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 $41.38 / $41.38 / $41.38	Facility	TC	$41.38	$41.38	$41.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.36 / $53.70 / $101.93	Professional		$35.36	$53.70	$101.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $13.58 / $26.30	Professional	26	$8.51	$13.58	$26.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.22 / $39.15 / $78.29	Professional	TC	$27.22	$39.15	$78.29
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $53.15 / $123.33 / $290.00	Facility		$53.15	$123.33	$290.00
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.61 / $12.72 / $13.35	Facility	26	$8.61	$12.72	$13.35
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $40.45 / $95.56 / $285.12	Facility	TC	$40.45	$95.56	$285.12
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $30.98 / $53.16 / $111.35	Professional		$30.98	$53.16	$111.35
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $12.72 / $32.25	Professional	26	$8.61	$12.72	$32.25
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $22.37 / $40.45 / $68.61	Professional	TC	$22.37	$40.45	$68.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $33.09 / $47.38	Professional		$26.52	$33.09	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $37.49 / $45.21 / $68.54	Professional		$37.49	$45.21	$68.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.21 / $12.04 / $18.51	Professional	26	$10.21	$12.04	$18.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.27 / $32.60 / $46.35	Professional	TC	$27.27	$32.60	$46.35