Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.15 / $245.81 / $601.83	Facility		$91.15	$245.81	$601.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.52 / $33.52 / $42.23	Facility	26	$33.52	$33.52	$42.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $67.12 / $129.19 / $384.79	Facility	TC	$67.12	$129.19	$384.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.71 / $107.68 / $420.23	Professional		$84.71	$107.68	$420.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.26 / $38.83 / $160.88	Professional	26	$25.26	$38.83	$160.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.74 / $80.89 / $154.63	Professional	TC	$54.74	$80.89	$154.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.51 / $78.65 / $84.57	Professional		$61.51	$78.65	$84.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.65 / $27.51 / $44.65	Professional	26	$20.65	$27.51	$44.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $40.95 / $40.95 / $94.03	Professional	TC	$40.95	$40.95	$94.03
BCBS Facility/Professional Facility Modifier Low / Median / High Price $101.41 / $140.41 / $244.07	Facility		$101.41	$140.41	$244.07
BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.34 / $101.49 / $155.38	Professional		$41.34	$101.49	$155.38
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.58 / $44.21 / $44.21	Professional	26	$37.58	$44.21	$44.21
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.13 / $94.27 / $94.27	Professional	TC	$80.13	$94.27	$94.27
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.51 / $63.18 / $109.84	Facility		$27.51	$63.18	$109.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $29.69 / $67.86 / $105.93	Professional		$29.69	$67.86	$105.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.31 / $97.31 / $97.31	Facility		$97.31	$97.31	$97.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.67 / $31.67 / $31.67	Facility	26	$31.67	$31.67	$31.67
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $66.73 / $66.73 / $66.73	Facility	TC	$66.73	$66.73	$66.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.98 / $110.28 / $238.04	Professional		$73.98	$110.28	$238.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.33 / $33.94 / $79.68	Professional	26	$22.33	$33.94	$79.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.95 / $72.19 / $182.35	Professional	TC	$48.95	$72.19	$182.35
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $96.23 / $301.35 / $636.00	Facility		$96.23	$301.35	$636.00
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $22.83 / $33.52 / $37.50	Facility	26	$22.83	$33.52	$37.50
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $64.59 / $124.17 / $453.52	Facility	TC	$64.59	$124.17	$453.52
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $86.28 / $104.19 / $282.20	Professional		$86.28	$104.19	$282.20
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $22.83 / $34.35 / $146.41	Professional	26	$22.83	$34.35	$146.41
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $62.40 / $70.98 / $143.54	Professional	TC	$62.40	$70.98	$143.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.56 / $79.45 / $123.28	Professional		$36.56	$79.45	$123.28
United Facility/Professional Facility Modifier Low / Median / High Price $108.97 / $108.97 / $108.97	Facility		$108.97	$108.97	$108.97
United Facility/Professional Professional Modifier Low / Median / High Price $85.98 / $104.16 / $144.59	Professional		$85.98	$104.16	$144.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.89 / $32.75 / $54.96	Professional	26	$25.89	$32.75	$54.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.79 / $71.48 / $109.62	Professional	TC	$57.79	$71.48	$109.62