Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $144.09 / $332.70 / $737.80	Facility		$144.09	$332.70	$737.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.89 / $26.89 / $33.89	Facility	26	$26.89	$26.89	$33.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.82 / $144.09 / $254.43	Professional		$113.82	$144.09	$254.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.44 / $26.89 / $58.37	Professional	26	$18.44	$26.89	$58.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.53 / $117.20 / $189.87	Professional	TC	$95.53	$117.20	$189.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.21 / $116.86 / $127.23	Professional		$92.21	$116.86	$127.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.54 / $21.52 / $32.28	Professional	26	$16.54	$21.52	$32.28
BCBS Facility/Professional Facility Modifier Low / Median / High Price $269.56 / $512.35 / $1,047.24	Facility		$269.56	$512.35	$1,047.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.36 / $187.19 / $240.68	Professional		$33.36	$187.19	$240.68
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.33 / $35.68 / $35.68	Professional	26	$30.33	$35.68	$35.68
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.07 / $190.67 / $190.67	Professional	TC	$162.07	$190.67	$190.67
CareSource Facility/Professional Facility Modifier Low / Median / High Price $22.59 / $126.95 / $177.81	Facility		$22.59	$126.95	$177.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.78 / $127.02 / $172.91	Professional		$23.78	$127.02	$172.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.30 / $147.30 / $147.30	Facility		$147.30	$147.30	$147.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.35 / $26.35 / $26.35	Facility	26	$26.35	$26.35	$26.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.47 / $188.47 / $408.21	Professional		$130.47	$188.47	$408.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.94 / $27.48 / $64.48	Professional	26	$20.94	$27.48	$64.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.71 / $161.56 / $348.50	Professional	TC	$111.71	$161.56	$348.50
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $144.10 / $455.63 / $737.80	Facility		$144.10	$455.63	$737.80
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $19.91 / $26.89 / $33.89	Facility	26	$19.91	$26.89	$33.89
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $123.81 / $172.91 / $239.31	Professional		$123.81	$172.91	$239.31
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $19.91 / $26.89 / $53.96	Professional	26	$19.91	$26.89	$53.96
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $102.26 / $137.87 / $206.11	Professional	TC	$102.26	$137.87	$206.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $111.53 / $167.33	Professional		$36.43	$111.53	$167.33
United Facility/Professional Professional Modifier Low / Median / High Price $149.66 / $183.27 / $250.54	Professional		$149.66	$183.27	$250.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $25.80 / $40.15	Professional	26	$20.42	$25.80	$40.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $121.71 / $158.69 / $225.00	Professional	TC	$121.71	$158.69	$225.00