Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $236.83 / $534.89 / $977.72	Facility		$236.83	$534.89	$977.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.04 / $44.04 / $55.50	Facility	26	$44.04	$44.04	$55.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $226.25 / $226.25 / $316.75	Facility	TC	$226.25	$226.25	$316.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.49 / $270.29 / $401.81	Professional		$178.49	$270.29	$401.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.85 / $39.67 / $74.94	Professional	26	$26.85	$39.67	$74.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $161.62 / $226.25 / $345.46	Professional	TC	$161.62	$226.25	$345.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $174.82 / $194.32 / $228.61	Professional		$174.82	$194.32	$228.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.82 / $33.97 / $52.85	Professional	26	$28.82	$33.97	$52.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $191.67 / $191.67 / $191.67	Professional	TC	$191.67	$191.67	$191.67
BCBS Facility/Professional Facility Modifier Low / Median / High Price $450.26 / $855.81 / $1,749.27	Facility		$450.26	$855.81	$1,749.27
BCBS Facility/Professional Professional Modifier Low / Median / High Price $233.41 / $331.23 / $402.02	Professional		$233.41	$331.23	$402.02
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.80 / $58.59 / $58.59	Professional	26	$49.80	$58.59	$58.59
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $270.72 / $318.49 / $318.49	Professional	TC	$270.72	$318.49	$318.49
CareSource Facility/Professional Facility Modifier Low / Median / High Price $36.94 / $211.33 / $296.00	Facility		$36.94	$211.33	$296.00
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.08 / $211.76 / $287.83	Professional		$39.08	$211.76	$287.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $268.80 / $268.80 / $268.80	Facility		$268.80	$268.80	$268.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.91 / $42.91 / $42.91	Facility	26	$42.91	$42.91	$42.91
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $227.42 / $227.42 / $227.42	Facility	TC	$227.42	$227.42	$227.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $216.52 / $314.35 / $690.59	Professional		$216.52	$314.35	$690.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.31 / $42.79 / $105.91	Professional	26	$31.31	$42.79	$105.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $197.80 / $270.27 / $581.71	Professional	TC	$197.80	$270.27	$581.71
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $270.29 / $650.75 / $1,233.41	Facility		$270.29	$650.75	$1,233.41
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $28.16 / $44.04 / $55.50	Facility	26	$28.16	$44.04	$55.50
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $226.25 / $278.97 / $534.52	Facility	TC	$226.25	$278.97	$534.52
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $194.20 / $283.80 / $388.63	Professional		$194.20	$283.80	$388.63
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $26.96 / $42.65 / $65.70	Professional	26	$26.96	$42.65	$65.70
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $176.56 / $243.07 / $335.46	Professional	TC	$176.56	$243.07	$335.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $208.62 / $307.44	Professional		$36.43	$208.62	$307.44
United Facility/Professional Professional Modifier Low / Median / High Price $245.82 / $305.38 / $419.37	Professional		$245.82	$305.38	$419.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.46 / $40.06 / $65.04	Professional	26	$29.46	$40.06	$65.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $212.09 / $266.61 / $360.42	Professional	TC	$212.09	$266.61	$360.42