Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $278.27 / $278.27 / $998.42	Facility		$278.27	$278.27	$998.42
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $288.48 / $288.48 / $355.99	Facility	TC	$288.48	$288.48	$355.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.63 / $93.58 / $189.36	Professional		$56.63	$93.58	$189.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.09 / $32.33 / $129.41	Professional	26	$20.09	$32.33	$129.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.36 / $83.35 / $148.97	Professional	TC	$57.36	$83.35	$148.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.19 / $107.85 / $107.85	Professional		$50.19	$107.85	$107.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.55 / $18.21 / $33.86	Professional	26	$12.55	$18.21	$33.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.10 / $38.10 / $111.73	Professional	TC	$38.10	$38.10	$111.73
BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.26 / $173.45 / $185.56	Professional		$40.26	$173.45	$185.56
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.76 / $30.76 / $41.01	Professional	26	$30.76	$30.76	$41.01
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $103.06 / $103.06 / $137.41	Professional	TC	$103.06	$103.06	$137.41
CareSource Facility/Professional Facility Modifier Low / Median / High Price $29.14 / $100.39 / $168.47	Facility		$29.14	$100.39	$168.47
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.28 / $91.04 / $191.89	Professional		$24.28	$91.04	$191.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.02 / $86.49 / $171.95	Professional		$48.02	$86.49	$171.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.66 / $25.05 / $72.86	Professional	26	$11.66	$25.05	$72.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $43.33 / $116.98	Professional	TC	$30.90	$43.33	$116.98
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $278.27 / $278.27 / $278.27	Facility		$278.27	$278.27	$278.27
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $96.16 / $237.33 / $355.99	Facility	TC	$96.16	$237.33	$355.99
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $66.19 / $107.51 / $191.00	Professional		$66.19	$107.51	$191.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $24.17 / $32.32 / $156.00	Professional	26	$24.17	$32.32	$156.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $65.39 / $84.48 / $129.10	Professional	TC	$65.39	$84.48	$129.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.47 / $106.56 / $147.02	Professional		$34.47	$106.56	$147.02
United Facility/Professional Professional Modifier Low / Median / High Price $61.51 / $87.91 / $139.35	Professional		$61.51	$87.91	$139.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $25.89 / $38.90	Professional	26	$16.67	$25.89	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.75 / $62.57 / $108.45	Professional	TC	$44.75	$62.57	$108.45