Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $236.00 / $473.84 / $944.23	Facility		$236.00	$473.84	$944.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.24 / $39.24 / $49.44	Facility	26	$39.24	$39.24	$49.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $173.27 / $181.93 / $596.21	Facility	TC	$173.27	$181.93	$596.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.31 / $212.51 / $403.56	Professional		$173.31	$212.51	$403.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.89 / $39.24 / $117.00	Professional	26	$31.89	$39.24	$117.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.13 / $173.27 / $297.89	Professional	TC	$142.13	$173.27	$297.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $133.35 / $178.65 / $197.41	Professional		$133.35	$178.65	$197.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.40 / $32.19 / $60.88	Professional	26	$24.40	$32.19	$60.88
BCBS Facility/Professional Facility Modifier Low / Median / High Price $344.11 / $654.04 / $1,336.85	Facility		$344.11	$654.04	$1,336.85
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.16 / $250.35 / $316.70	Professional		$51.16	$250.35	$316.70
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.46 / $51.13 / $51.13	Professional	26	$43.46	$51.13	$51.13
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $206.89 / $243.40 / $243.40	Professional	TC	$206.89	$243.40	$243.40
CareSource Facility/Professional Facility Modifier Low / Median / High Price $32.19 / $163.04 / $231.64	Facility		$32.19	$163.04	$231.64
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.14 / $165.56 / $223.51	Professional		$34.14	$165.56	$223.51
Cigna Facility/Professional Facility Modifier Low / Median / High Price $209.15 / $209.15 / $209.15	Facility		$209.15	$209.15	$209.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.51 / $37.51 / $37.51	Facility	26	$37.51	$37.51	$37.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $172.98 / $172.98 / $172.98	Facility	TC	$172.98	$172.98	$172.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $178.83 / $245.07 / $526.22	Professional		$178.83	$245.07	$526.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.64 / $40.93 / $92.61	Professional	26	$32.64	$40.93	$92.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $149.13 / $206.33 / $439.83	Professional	TC	$149.13	$206.33	$439.83
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $236.00 / $569.16 / $999.74	Facility		$236.00	$569.16	$999.74
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $34.15 / $39.24 / $41.20	Facility	26	$34.15	$39.24	$41.20
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $173.27 / $218.32 / $1,099.74	Facility	TC	$173.27	$218.32	$1,099.74
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $183.69 / $238.53 / $370.17	Professional		$183.69	$238.53	$370.17
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $39.24 / $92.47	Professional	26	$32.11	$39.24	$92.47
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $152.00 / $192.91 / $292.33	Professional	TC	$152.00	$192.91	$292.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $176.23 / $262.80	Professional		$36.43	$176.23	$262.80
United Facility/Professional Professional Modifier Low / Median / High Price $194.25 / $237.16 / $331.26	Professional		$194.25	$237.16	$331.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.57 / $39.89 / $59.33	Professional	26	$32.57	$39.89	$59.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $160.69 / $197.94 / $291.18	Professional	TC	$160.69	$197.94	$291.18