Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $746.41 / $746.41 / $746.41	Facility		$746.41	$746.41	$746.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.70 / $134.71 / $213.15	Professional		$103.70	$134.71	$213.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.07 / $63.62 / $168.15	Professional	26	$58.07	$63.62	$168.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.86 / $78.90 / $179.77	Professional	TC	$61.86	$78.90	$179.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.83 / $47.70 / $85.36	Professional	26	$32.83	$47.70	$85.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.63 / $205.32 / $345.56	Professional		$105.63	$205.32	$345.56
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.69 / $80.69 / $107.59	Professional	26	$80.69	$80.69	$107.59
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $124.63 / $124.63 / $124.63	Professional	TC	$124.63	$124.63	$124.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $76.33 / $136.79 / $241.90	Facility		$76.33	$136.79	$241.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $63.61 / $145.66 / $232.92	Professional		$63.61	$145.66	$232.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.78 / $129.88 / $292.82	Professional		$73.78	$129.88	$292.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.59 / $65.34 / $187.92	Professional	26	$30.59	$65.34	$187.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.53 / $49.85 / $142.16	Professional	TC	$34.53	$49.85	$142.16
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $103.70 / $145.37 / $259.14	Professional		$103.70	$145.37	$259.14
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $63.61 / $67.51 / $173.72	Professional	26	$63.61	$67.51	$173.72
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $68.66 / $81.73 / $155.71	Professional	TC	$68.66	$81.73	$155.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.32 / $97.03 / $178.01	Professional		$61.32	$97.03	$178.01
United Facility/Professional Professional Modifier Low / Median / High Price $83.33 / $130.53 / $220.29	Professional		$83.33	$130.53	$220.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.35 / $67.06 / $103.57	Professional	26	$43.35	$67.06	$103.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.22 / $65.70 / $116.72	Professional	TC	$40.22	$65.70	$116.72