Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.81 / $280.68 / $932.28	Facility		$38.81	$280.68	$932.28
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.81 / $46.79 / $93.58	Facility	TC	$38.81	$46.79	$93.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.88 / $78.30 / $291.39	Professional		$51.88	$78.30	$291.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.70 / $66.59 / $361.86	Professional	26	$31.70	$66.59	$361.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.00 / $43.07 / $59.27	Professional	52	$27.00	$43.07	$59.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.42 / $43.61 / $160.74	Professional	TC	$29.42	$43.61	$160.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.79 / $33.92 / $69.45	Professional		$32.79	$33.92	$69.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.03 / $34.07 / $47.37	Professional	26	$17.03	$34.07	$47.37
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.81 / $15.81 / $47.43	Professional	TC	$15.81	$15.81	$47.43
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.78 / $57.20 / $132.57	Professional		$46.78	$57.20	$132.57
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $55.00 / $55.00	Professional	26	$55.00	$55.00	$55.00
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.03 / $50.03 / $50.03	Professional	TC	$50.03	$50.03	$50.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $34.02 / $52.48 / $97.42	Facility		$34.02	$52.48	$97.42
CareSource Facility/Professional Professional Modifier Low / Median / High Price $31.57 / $65.59 / $90.30	Professional		$31.57	$65.59	$90.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.17 / $69.84 / $231.26	Professional		$33.17	$69.84	$231.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.35 / $34.99 / $128.25	Professional	26	$16.35	$34.99	$128.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.88 / $32.81 / $63.29	Professional	TC	$14.88	$32.81	$63.29
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $68.58 / $77.62 / $561.45	Facility		$68.58	$77.62	$561.45
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $38.81 / $56.14 / $93.58	Facility	TC	$38.81	$56.14	$93.58
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $86.12 / $249.38	Professional		$64.31	$86.12	$249.38
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $51.42 / $676.35	Professional	26	$33.88	$51.42	$676.35
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $32.22 / $45.35 / $194.00	Professional	52	$32.22	$45.35	$194.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $30.55 / $45.96 / $133.97	Professional	TC	$30.55	$45.96	$133.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.56 / $44.71 / $78.23	Professional		$28.56	$44.71	$78.23
United Facility/Professional Professional Modifier Low / Median / High Price $42.88 / $76.01 / $110.81	Professional		$42.88	$76.01	$110.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.36 / $35.74 / $55.08	Professional	26	$23.36	$35.74	$55.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.27 / $41.61 / $71.76	Professional	TC	$19.27	$41.61	$71.76