Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $267.45 / $935.39 / $2,042.76	Facility		$267.45	$935.39	$2,042.76
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.01 / $90.01 / $163.37	Facility	26	$90.01	$90.01	$163.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.66 / $254.66 / $734.26	Professional		$189.66	$254.66	$734.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.06 / $79.23 / $249.00	Professional	26	$64.06	$79.23	$249.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.74 / $175.12 / $429.59	Professional	TC	$134.74	$175.12	$429.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $124.84 / $176.00 / $316.80	Professional		$124.84	$176.00	$316.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.25 / $79.42 / $96.11	Professional	26	$56.25	$79.42	$96.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $285.38 / $542.41 / $1,108.70	Facility		$285.38	$542.41	$1,108.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.60 / $274.86 / $361.66	Professional		$100.60	$274.86	$361.66
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.45 / $107.59 / $107.59	Professional	26	$91.45	$107.59	$107.59
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $171.58 / $201.86 / $201.86	Professional	TC	$171.58	$201.86	$201.86
CareSource Facility/Professional Facility Modifier Low / Median / High Price $66.39 / $139.75 / $245.97	Facility		$66.39	$139.75	$245.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.63 / $145.34 / $237.56	Professional		$72.63	$145.34	$237.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $219.59 / $219.59 / $219.59	Facility		$219.59	$219.59	$219.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.29 / $292.33 / $616.13	Professional		$185.29	$292.33	$616.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.34 / $92.84 / $198.88	Professional	26	$68.34	$92.84	$198.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.52 / $202.73 / $407.32	Professional	TC	$134.52	$202.73	$407.32
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $361.71 / $901.20 / $2,287.60	Facility		$361.71	$901.20	$2,287.60
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $63.16 / $90.01 / $113.42	Facility	26	$63.16	$90.01	$113.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $193.19 / $250.77 / $700.39	Professional		$193.19	$250.77	$700.39
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $63.16 / $80.98 / $205.63	Professional	26	$63.16	$80.98	$205.63
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $134.32 / $160.75 / $267.31	Professional	TC	$134.32	$160.75	$267.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.90 / $130.20 / $203.84	Professional		$61.90	$130.20	$203.84
United Facility/Professional Professional Modifier Low / Median / High Price $200.92 / $260.23 / $388.41	Professional		$200.92	$260.23	$388.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.09 / $82.58 / $106.33	Professional	26	$67.09	$82.58	$106.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $136.41 / $190.27 / $295.29	Professional	TC	$136.41	$190.27	$295.29