Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $174.65 / $174.65 / $4,154.30	Facility		$174.65	$174.65	$4,154.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.82 / $97.82 / $123.26	Facility	26	$97.82	$97.82	$123.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.10 / $211.53 / $335.62	Professional		$131.10	$211.53	$335.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $75.90 / $147.53	Professional	26	$48.86	$75.90	$147.53
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $54.89 / $87.33 / $105.77	Professional	52	$54.89	$87.33	$105.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.06 / $126.48 / $221.75	Professional	TC	$61.06	$126.48	$221.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.99 / $113.99 / $113.99	Professional		$113.99	$113.99	$113.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.45 / $83.35 / $104.64	Professional	26	$65.45	$83.35	$104.64
BCBS Facility/Professional Facility Modifier Low / Median / High Price $112.69 / $160.27 / $278.55	Facility		$112.69	$160.27	$278.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.57 / $138.59 / $254.27	Professional		$95.57	$138.59	$254.27
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $128.88 / $128.88 / $128.88	Professional	26	$128.88	$128.88	$128.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $59.96 / $94.59 / $186.48	Facility		$59.96	$94.59	$186.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $65.95 / $100.39 / $186.48	Professional		$65.95	$100.39	$186.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $167.76 / $167.76 / $167.76	Facility		$167.76	$167.76	$167.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $94.06 / $94.06	Facility	26	$94.06	$94.06	$94.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.80 / $257.56 / $542.47	Professional		$130.80	$257.56	$542.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.54 / $89.77 / $174.51	Professional	26	$56.54	$89.77	$174.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.21 / $128.36 / $476.03	Professional	TC	$60.21	$128.36	$476.03
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $163.41 / $174.65 / $4,154.30	Facility		$163.41	$174.65	$4,154.30
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $43.60 / $97.82 / $97.83	Facility	26	$43.60	$97.82	$97.83
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $158.96 / $183.03 / $279.00	Professional		$158.96	$183.03	$279.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $43.60 / $82.90 / $141.69	Professional	26	$43.60	$82.90	$141.69
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $58.41 / $87.33 / $238.52	Professional	52	$58.41	$87.33	$238.52
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $71.63 / $119.82 / $199.64	Professional	TC	$71.63	$119.82	$199.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $56.25 / $85.47 / $154.58	Professional		$56.25	$85.47	$154.58
United Facility/Professional Professional Modifier Low / Median / High Price $158.74 / $201.19 / $502.56	Professional		$158.74	$201.19	$502.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.01 / $72.92 / $106.11	Professional	26	$54.01	$72.92	$106.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.73 / $123.54 / $346.78	Professional	TC	$74.73	$123.54	$346.78