Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.05 / $602.99 / $642.19	Facility		$62.05	$602.99	$642.19
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.20 / $33.20 / $66.41	Facility	TC	$33.20	$33.20	$66.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.79 / $60.07 / $99.51	Professional		$51.79	$60.07	$99.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.77 / $26.61 / $128.02	Professional	26	$20.77	$26.61	$128.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.61 / $38.14 / $52.54	Professional	TC	$32.61	$38.14	$52.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.25 / $30.76 / $65.53	Professional		$30.25	$30.76	$65.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.03 / $18.92 / $27.96	Professional	26	$13.03	$18.92	$27.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.19 / $96.04 / $136.47	Professional		$58.19	$96.04	$136.47
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.96 / $31.96 / $42.61	Professional	26	$31.96	$31.96	$42.61
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $49.13 / $49.13 / $49.13	Professional	TC	$49.13	$49.13	$49.13
CareSource Facility/Professional Facility Modifier Low / Median / High Price $30.28 / $53.88 / $95.30	Facility		$30.28	$53.88	$95.30
CareSource Facility/Professional Professional Modifier Low / Median / High Price $25.23 / $57.88 / $91.52	Professional		$25.23	$57.88	$91.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.88 / $68.89 / $283.35	Professional		$29.88	$68.89	$283.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.11 / $32.63 / $121.06	Professional	26	$12.11	$32.63	$121.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $41.95 / $61.95	Professional	TC	$17.57	$41.95	$61.95
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $642.19 / $642.19 / $642.19	Facility		$642.19	$642.19	$642.19
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $33.20 / $35.79 / $66.41	Facility	TC	$33.20	$35.79	$66.41
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $59.35 / $79.52 / $111.40	Professional		$59.35	$79.52	$111.40
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $40.65 / $127.30	Professional	26	$25.12	$40.65	$127.30
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $34.95 / $44.77 / $61.17	Professional	TC	$34.95	$44.77	$61.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.56 / $44.67 / $78.23	Professional		$28.56	$44.67	$78.23
United Facility/Professional Professional Modifier Low / Median / High Price $41.14 / $75.43 / $120.67	Professional		$41.14	$75.43	$120.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.32 / $35.15 / $57.75	Professional	26	$17.32	$35.15	$57.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $39.70 / $55.58	Professional	TC	$23.82	$39.70	$55.58