Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $419.22 / $419.22 / $419.22	Facility		$419.22	$419.22	$419.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.95 / $121.56 / $242.06	Professional		$75.95	$121.56	$242.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.16 / $48.07 / $136.16	Professional	26	$31.16	$48.07	$136.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.21 / $73.48 / $137.05	Professional	TC	$50.21	$73.48	$137.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.89 / $28.39 / $50.67	Professional	26	$18.89	$28.39	$50.67
BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.94 / $142.61 / $197.75	Professional		$63.94	$142.61	$197.75
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.93 / $47.93 / $63.91	Professional	26	$47.93	$47.93	$63.91
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.67 / $94.67 / $94.67	Professional	TC	$94.67	$94.67	$94.67
CareSource Facility/Professional Facility Modifier Low / Median / High Price $45.42 / $99.35 / $181.37	Facility		$45.42	$99.35	$181.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.85 / $87.41 / $175.80	Professional		$37.85	$87.41	$175.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.37 / $108.45 / $193.39	Professional		$55.37	$108.45	$193.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.14 / $49.42 / $99.07	Professional	26	$18.14	$49.42	$99.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.70 / $50.04 / $127.48	Professional	TC	$34.70	$50.04	$127.48
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $105.78 / $133.72 / $204.90	Professional		$105.78	$133.72	$204.90
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.07 / $50.77 / $170.28	Professional	26	$39.07	$50.77	$170.28
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $67.02 / $83.90 / $128.88	Professional	TC	$67.02	$83.90	$128.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.97 / $81.13 / $156.51	Professional		$35.97	$81.13	$156.51
United Facility/Professional Professional Modifier Low / Median / High Price $72.09 / $113.04 / $178.36	Professional		$72.09	$113.04	$178.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.42 / $50.16 / $68.81	Professional	26	$26.42	$50.16	$68.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.88 / $63.89 / $116.72	Professional	TC	$40.88	$63.89	$116.72