Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.23 / $337.50 / $742.81	Facility		$104.23	$337.50	$742.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.23 / $25.23 / $31.80	Facility	26	$25.23	$25.23	$31.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $109.42 / $153.19 / $390.14	Facility	TC	$109.42	$153.19	$390.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.40 / $134.65 / $292.19	Professional		$82.40	$134.65	$292.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.03 / $26.50 / $97.57	Professional	26	$21.03	$26.50	$97.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.35 / $109.42 / $215.14	Professional	TC	$90.35	$109.42	$215.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $82.83 / $106.03 / $131.22	Professional		$82.83	$106.03	$131.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.36 / $19.82 / $33.25	Professional	26	$15.36	$19.82	$33.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $82.86 / $82.86 / $82.86	Professional	TC	$82.86	$82.86	$82.86
BCBS Facility/Professional Facility Modifier Low / Median / High Price $219.87 / $417.90 / $854.18	Facility		$219.87	$417.90	$854.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.10 / $155.59 / $211.54	Professional		$32.10	$155.59	$211.54
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.07 / $33.02 / $33.02	Professional	26	$28.07	$33.02	$33.02
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $132.19 / $132.19 / $155.52	Professional	TC	$132.19	$132.19	$155.52
CareSource Facility/Professional Facility Modifier Low / Median / High Price $20.73 / $104.16 / $148.29	Facility		$20.73	$104.16	$148.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $22.08 / $106.00 / $143.10	Professional		$22.08	$106.00	$143.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $133.10 / $133.10 / $133.10	Facility		$133.10	$133.10	$133.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.98 / $23.98 / $23.98	Facility	26	$23.98	$23.98	$23.98
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $109.98 / $109.98 / $109.98	Facility	TC	$109.98	$109.98	$109.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.00 / $158.71 / $342.45	Professional		$110.00	$158.71	$342.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.98 / $27.12 / $60.81	Professional	26	$20.98	$27.12	$60.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.05 / $133.19 / $288.97	Professional	TC	$90.05	$133.19	$288.97
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $134.65 / $402.38 / $765.18	Facility		$134.65	$402.38	$765.18
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $22.27 / $25.23 / $31.80	Facility	26	$22.27	$25.23	$31.80
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $109.42 / $133.26 / $775.38	Facility	TC	$109.42	$133.26	$775.38
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $93.00 / $141.38 / $237.87	Professional		$93.00	$141.38	$237.87
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $21.03 / $25.49 / $87.66	Professional	26	$21.03	$25.49	$87.66
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $99.15 / $120.70 / $183.21	Professional	TC	$99.15	$120.70	$183.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $79.57 / $100.92 / $144.95	Professional		$79.57	$100.92	$144.95
United Facility/Professional Professional Modifier Low / Median / High Price $118.84 / $155.66 / $220.63	Professional		$118.84	$155.66	$220.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.08 / $26.38 / $68.50	Professional	26	$22.08	$26.38	$68.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.34 / $135.18 / $218.97	Professional	TC	$96.34	$135.18	$218.97