Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $65.18 / $570.45 / $964.41	Facility		$65.18	$570.45	$964.41
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $65.18 / $782.15 / $985.75	Facility	TC	$65.18	$782.15	$985.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.78 / $77.03 / $163.05	Professional		$59.78	$77.03	$163.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.98 / $43.12 / $378.84	Professional	26	$19.98	$43.12	$378.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.00 / $56.98 / $176.76	Professional	TC	$41.00	$56.98	$176.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.43 / $43.43 / $43.43	Professional		$43.43	$43.43	$43.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.35 / $16.30 / $31.03	Professional	26	$13.35	$16.30	$31.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.50 / $30.50 / $30.50	Professional	TC	$30.50	$30.50	$30.50
BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.83 / $136.72 / $160.08	Professional		$40.83	$136.72	$160.08
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.75 / $32.75 / $43.67	Professional	26	$32.75	$32.75	$43.67
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.69 / $82.69 / $110.25	Professional	TC	$82.69	$82.69	$110.25
CareSource Facility/Professional Facility Modifier Low / Median / High Price $30.98 / $86.58 / $145.65	Facility		$30.98	$86.58	$145.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $25.82 / $72.62 / $153.07	Professional		$25.82	$72.62	$153.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.18 / $59.51 / $152.06	Professional		$38.18	$59.51	$152.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.86 / $20.04 / $49.07	Professional	26	$11.86	$20.04	$49.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.86 / $39.47 / $96.96	Professional	TC	$25.86	$39.47	$96.96
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $65.18 / $471.50 / $627.29	Facility		$65.18	$471.50	$627.29
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $65.18 / $782.15 / $1,164.98	Facility	TC	$65.18	$782.15	$1,164.98
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $62.18 / $82.91 / $154.00	Professional		$62.18	$82.91	$154.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $16.30 / $36.08 / $435.60	Professional	26	$16.30	$36.08	$435.60
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $33.97 / $64.05 / $102.64	Professional	TC	$33.97	$64.05	$102.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.47 / $74.89 / $109.88	Professional		$34.47	$74.89	$109.88
United Facility/Professional Professional Modifier Low / Median / High Price $43.83 / $67.90 / $131.87	Professional		$43.83	$67.90	$131.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.19 / $23.62 / $41.43	Professional	26	$14.19	$23.62	$41.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.93 / $46.12 / $86.13	Professional	TC	$29.93	$46.12	$86.13