Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $139.52 / $181.96 / $650.40	Facility		$139.52	$181.96	$650.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.73 / $25.73 / $32.43	Facility	26	$25.73	$25.73	$32.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.71 / $173.30 / $272.38	Professional		$130.71	$173.30	$272.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.71 / $25.73 / $48.22	Professional	26	$20.71	$25.73	$48.22
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.91 / $72.20 / $72.29	Professional	52	$59.91	$72.20	$72.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $110.59 / $146.75 / $238.23	Professional	TC	$110.59	$146.75	$238.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.28 / $126.21 / $164.07	Professional		$107.28	$126.21	$164.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.71 / $21.52 / $29.05	Professional	26	$16.71	$21.52	$29.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $88.98 / $88.98 / $88.98	Professional	TC	$88.98	$88.98	$88.98
BCBS Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $466.56 / $953.65	Facility		$245.47	$466.56	$953.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.37 / $180.58 / $232.45	Professional		$31.37	$180.58	$232.45
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $33.54 / $33.54	Professional	26	$33.54	$33.54	$33.54
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $173.63 / $173.63 / $173.63	Professional	TC	$173.63	$173.63	$173.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $21.52 / $116.02 / $162.72	Facility		$21.52	$116.02	$162.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $22.17 / $116.16 / $158.24	Professional		$22.17	$116.16	$158.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $145.77 / $145.77 / $145.77	Facility		$145.77	$145.77	$145.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.72 / $24.72 / $24.72	Facility	26	$24.72	$24.72	$24.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.12 / $172.37 / $368.67	Professional		$117.12	$172.37	$368.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.95 / $26.87 / $59.78	Professional	26	$20.95	$26.87	$59.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.12 / $148.24 / $305.41	Professional	TC	$104.12	$148.24	$305.41
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $144.41 / $270.18 / $678.83	Facility		$144.41	$270.18	$678.83
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $22.27 / $25.73 / $32.43	Facility	26	$22.27	$25.73	$32.43
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $133.66 / $156.40 / $235.21	Professional		$133.66	$156.40	$235.21
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $21.17 / $25.73 / $41.39	Professional	26	$21.17	$25.73	$41.39
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $61.23 / $72.20 / $189.10	Professional	52	$61.23	$72.20	$189.10
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $115.58 / $134.12 / $204.22	Professional	TC	$115.58	$134.12	$204.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $80.42 / $100.92 / $144.95	Professional		$80.42	$100.92	$144.95
United Facility/Professional Professional Modifier Low / Median / High Price $130.15 / $164.93 / $240.16	Professional		$130.15	$164.93	$240.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.18 / $27.14 / $57.78	Professional	26	$22.18	$27.14	$57.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $111.73 / $140.00 / $206.20	Professional	TC	$111.73	$140.00	$206.20