Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $130.96 / $180.03 / $251.85	Facility		$130.96	$180.03	$251.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.21 / $47.20 / $59.79	Professional		$29.21	$47.20	$59.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.68 / $8.41 / $51.80	Professional	26	$5.68	$8.41	$51.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.92 / $41.79 / $53.33	Professional	TC	$22.92	$41.79	$53.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.44 / $32.44 / $32.44	Professional		$32.44	$32.44	$32.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $3.15 / $3.35 / $8.69	Professional	26	$3.15	$3.35	$8.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $11.54 / $11.54 / $11.54	Professional	TC	$11.54	$11.54	$11.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.96 / $44.31 / $67.23	Professional		$9.96	$44.31	$67.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.99 / $7.99 / $10.65	Professional	26	$7.99	$7.99	$10.65
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.96 / $31.96 / $42.61	Professional	TC	$31.96	$31.96	$42.61
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.57 / $29.92 / $50.35	Facility		$7.57	$29.92	$50.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $6.31 / $28.33 / $59.71	Professional		$6.31	$28.33	$59.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $14.29 / $31.38 / $78.45	Professional		$14.29	$31.38	$78.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.06 / $6.15 / $28.01	Professional	26	$3.06	$6.15	$28.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.59 / $14.14 / $44.73	Professional	TC	$10.59	$14.14	$44.73
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $29.12 / $29.12 / $29.12	Facility		$29.12	$29.12	$29.12
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $32.43 / $46.71 / $59.14	Professional		$32.43	$46.71	$59.14
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.29 / $8.41 / $51.80	Professional	26	$6.29	$8.41	$51.80
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $24.84 / $33.92 / $50.16	Professional	TC	$24.84	$33.92	$50.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.06 / $32.30 / $40.96	Professional		$26.06	$32.30	$40.96
United Facility/Professional Professional Modifier Low / Median / High Price $18.84 / $33.54 / $57.41	Professional		$18.84	$33.54	$57.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.23 / $6.44 / $10.11	Professional	26	$4.23	$6.44	$10.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.51 / $26.65 / $46.06	Professional	TC	$14.51	$26.65	$46.06