Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.88 / $45.88 / $91.75	Facility		$45.88	$45.88	$91.75
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $116.57 / $116.57 / $116.57	Facility	TC	$116.57	$116.57	$116.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.40 / $92.43 / $170.78	Professional		$79.40	$92.43	$170.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.28 / $75.27 / $755.41	Professional	26	$54.28	$75.27	$755.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.11 / $36.13 / $70.43	Professional	TC	$30.11	$36.13	$70.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.27 / $42.41 / $76.09	Professional	26	$29.27	$42.41	$76.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.80 / $120.64 / $167.28	Professional		$63.80	$120.64	$167.28
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.87 / $95.87 / $95.87	Professional	26	$95.87	$95.87	$95.87
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.74 / $48.74 / $48.74	Professional	TC	$48.74	$48.74	$48.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $43.19 / $84.00 / $139.80	Facility		$43.19	$84.00	$139.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.99 / $79.23 / $135.72	Professional		$35.99	$79.23	$135.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.48 / $87.58 / $210.44	Professional		$46.48	$87.58	$210.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.31 / $57.08 / $161.12	Professional	26	$27.31	$57.08	$161.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.70 / $23.97 / $55.34	Professional	TC	$16.70	$23.97	$55.34
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $45.88 / $45.88 / $91.75	Facility		$45.88	$45.88	$91.75
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $45.88 / $66.39 / $116.57	Facility	TC	$45.88	$66.39	$116.57
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $89.50 / $110.29 / $165.44	Professional		$89.50	$110.29	$165.44
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $56.31 / $75.26 / $438.08	Professional	26	$56.31	$75.26	$438.08
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.65 / $42.04 / $60.84	Professional	TC	$32.65	$42.04	$60.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.53 / $65.66 / $107.26	Professional		$29.53	$65.66	$107.26
United Facility/Professional Professional Modifier Low / Median / High Price $56.76 / $87.95 / $140.46	Professional		$56.76	$87.95	$140.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.78 / $58.46 / $91.45	Professional	26	$37.78	$58.46	$91.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.98 / $28.06 / $45.15	Professional	TC	$18.98	$28.06	$45.15