Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $99.77 / $300.30 / $701.55	Facility		$99.77	$300.30	$701.55
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.42 / $45.42 / $57.24	Facility	26	$45.42	$45.42	$57.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.07 / $136.78 / $458.93	Professional		$112.07	$136.78	$458.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.43 / $171.24	Professional	26	$34.67	$45.43	$171.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.73 / $99.56 / $189.38	Professional	TC	$71.73	$99.56	$189.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.86 / $111.51 / $112.55	Professional		$81.86	$111.51	$112.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.25 / $37.75 / $75.59	Professional	26	$28.25	$37.75	$75.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.61 / $74.47 / $100.52	Professional	TC	$53.61	$74.47	$100.52
BCBS Facility/Professional Facility Modifier Low / Median / High Price $129.41 / $184.05 / $319.89	Facility		$129.41	$184.05	$319.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.77 / $156.63 / $198.15	Professional		$56.77	$156.63	$198.15
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.61 / $60.72 / $60.72	Professional	26	$51.61	$60.72	$60.72
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $105.03 / $123.56 / $123.56	Professional	TC	$105.03	$123.56	$123.56
CareSource Facility/Professional Facility Modifier Low / Median / High Price $37.75 / $82.69 / $146.13	Facility		$37.75	$82.69	$146.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $40.79 / $88.97 / $141.12	Professional		$40.79	$88.97	$141.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $130.11 / $130.11 / $130.11	Facility		$130.11	$130.11	$130.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.62 / $43.62 / $43.62	Facility	26	$43.62	$43.62	$43.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.86 / $155.24 / $321.72	Professional		$103.86	$155.24	$321.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.83 / $47.16 / $111.64	Professional	26	$30.83	$47.16	$111.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.29 / $99.72 / $231.59	Professional	TC	$67.29	$99.72	$231.59
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $102.67 / $362.00 / $831.73	Facility		$102.67	$362.00	$831.73
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $31.49 / $45.42 / $51.95	Facility	26	$31.49	$45.42	$51.95
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $112.68 / $136.03 / $268.23	Professional		$112.68	$136.03	$268.23
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $31.49 / $45.42 / $113.50	Professional	26	$31.49	$45.42	$113.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $81.18 / $89.29 / $167.28	Professional	TC	$81.18	$89.29	$167.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.97 / $80.86 / $158.16	Professional		$35.97	$80.86	$158.16
United Facility/Professional Professional Modifier Low / Median / High Price $113.51 / $139.40 / $193.63	Professional		$113.51	$139.40	$193.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.59 / $44.82 / $62.79	Professional	26	$35.59	$44.82	$62.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.31 / $92.35 / $136.12	Professional	TC	$76.31	$92.35	$136.12