Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.19 / $300.30 / $657.02	Facility		$104.19	$300.30	$657.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.46 / $41.46 / $54.74	Facility	26	$41.46	$41.46	$54.74
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $82.68 / $107.69 / $333.21	Facility	TC	$82.68	$107.69	$333.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.87 / $133.18 / $345.10	Professional		$103.87	$133.18	$345.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.67 / $44.35 / $154.00	Professional	26	$31.67	$44.35	$154.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $35.94 / $62.08 / $62.08	Professional	52	$35.94	$62.08	$62.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.95 / $90.94 / $180.04	Professional	TC	$65.95	$90.94	$180.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.54 / $104.84 / $164.41	Professional		$80.54	$104.84	$164.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.85 / $34.52 / $65.86	Professional	26	$25.85	$34.52	$65.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.60 / $70.31 / $70.31	Professional	TC	$50.60	$70.31	$70.31
BCBS Facility/Professional Facility Modifier Low / Median / High Price $122.17 / $173.75 / $308.97	Facility		$122.17	$173.75	$308.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.79 / $152.81 / $201.06	Professional		$51.79	$152.81	$201.06
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.08 / $55.39 / $55.39	Professional	26	$47.08	$55.39	$55.39
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $99.14 / $116.64 / $116.64	Professional	TC	$99.14	$116.64	$116.64
CareSource Facility/Professional Facility Modifier Low / Median / High Price $34.52 / $78.04 / $136.29	Facility		$34.52	$78.04	$136.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.17 / $83.99 / $131.69	Professional		$37.17	$83.99	$131.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $121.16 / $121.16 / $121.16	Facility		$121.16	$121.16	$121.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $40.13	Facility	26	$40.13	$40.13	$40.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $82.40	Facility	TC	$82.40	$82.40	$82.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.73 / $139.57 / $293.00	Professional		$91.73	$139.57	$293.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $42.69 / $99.52	Professional	26	$28.14	$42.69	$99.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.83 / $90.80 / $220.99	Professional	TC	$61.83	$90.80	$220.99
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $106.86 / $353.23 / $699.03	Facility		$106.86	$353.23	$699.03
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $28.85 / $41.46 / $52.25	Facility	26	$28.85	$41.46	$52.25
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $82.68 / $107.69 / $562.55	Facility	TC	$82.68	$107.69	$562.55
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $106.86 / $124.59 / $242.48	Professional		$106.86	$124.59	$242.48
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.85 / $41.47 / $142.50	Professional	26	$28.85	$41.47	$142.50
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $47.94 / $62.08 / $136.88	Professional	52	$47.94	$62.08	$136.88
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $77.06 / $86.81 / $145.52	Professional	TC	$77.06	$86.81	$145.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.97 / $77.58 / $119.35	Professional		$35.97	$77.58	$119.35
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 $107.73 / $129.82 / $182.06	Professional		$107.73	$129.82	$182.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.90 / $39.10 / $54.62	Professional	26	$31.90	$39.10	$54.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.23 / $90.27 / $131.11	Professional	TC	$72.23	$90.27	$131.11