Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $233.05 / $699.16 / $1,398.32	Facility		$233.05	$699.16	$1,398.32
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $285.37 / $570.74 / $856.11	Facility	TC	$285.37	$570.74	$856.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.92 / $258.37 / $484.79	Professional		$182.92	$258.37	$484.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.63 / $81.11 / $397.10	Professional	26	$60.63	$81.11	$397.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.18 / $183.51 / $359.94	Professional	TC	$131.18	$183.51	$359.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $129.13 / $133.25 / $276.82	Professional		$129.13	$133.25	$276.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.59 / $55.90 / $100.32	Professional	26	$38.59	$55.90	$100.32
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $269.52 / $269.52 / $269.52	Professional	TC	$269.52	$269.52	$269.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $294.73 / $406.86 / $578.16	Professional		$294.73	$406.86	$578.16
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.67 / $94.67 / $126.23	Professional	26	$94.67	$94.67	$126.23
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $248.86 / $248.86 / $248.86	Professional	TC	$248.86	$248.86	$248.86
CareSource Facility/Professional Facility Modifier Low / Median / High Price $89.44 / $258.27 / $433.93	Facility		$89.44	$258.27	$433.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.53 / $219.60 / $462.88	Professional		$74.53	$219.60	$462.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.37 / $217.44 / $474.48	Professional		$131.37	$217.44	$474.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.95 / $76.18 / $215.60	Professional	26	$35.95	$76.18	$215.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.10 / $124.44 / $282.12	Professional	TC	$89.10	$124.44	$282.12
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $321.14 / $699.16 / $1,398.32	Facility		$321.14	$699.16	$1,398.32
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $233.05 / $285.37 / $856.11	Facility	TC	$233.05	$285.37	$856.11
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $225.62 / $276.81 / $470.59	Professional		$225.62	$276.81	$470.59
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $74.12 / $100.07 / $814.51	Professional	26	$74.12	$100.07	$814.51
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $149.84 / $199.64 / $311.43	Professional	TC	$149.84	$199.64	$311.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.67 / $197.90 / $341.08	Professional		$93.67	$197.90	$341.08
United Facility/Professional Professional Modifier Low / Median / High Price $131.74 / $219.59 / $394.10	Professional		$131.74	$219.59	$394.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.27 / $77.26 / $121.27	Professional	26	$50.27	$77.26	$121.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.79 / $133.38 / $253.66	Professional	TC	$82.79	$133.38	$253.66