Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.25 / $376.09 / $928.18	Facility		$204.25	$376.09	$928.18
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.06 / $45.06 / $56.77	Facility	26	$45.06	$45.06	$56.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $174.46 / $204.25 / $351.10	Professional		$174.46	$204.25	$351.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.82 / $45.06 / $85.70	Professional	26	$30.82	$45.06	$85.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.75 / $162.49 / $265.99	Professional	TC	$131.75	$162.49	$265.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.15 / $175.58 / $228.25	Professional		$134.15	$175.58	$228.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.61 / $39.64 / $72.12	Professional	26	$30.61	$39.64	$72.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $319.25 / $606.79 / $1,240.29	Facility		$319.25	$606.79	$1,240.29
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.77 / $254.51 / $298.00	Professional		$56.77	$254.51	$298.00
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.61 / $60.72 / $60.72	Professional	26	$51.61	$60.72	$60.72
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $225.82 / $225.82 / $225.82	Professional	TC	$225.82	$225.82	$225.82
CareSource Facility/Professional Facility Modifier Low / Median / High Price $39.64 / $151.24 / $224.49	Facility		$39.64	$151.24	$224.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $40.19 / $157.54 / $217.93	Professional		$40.19	$157.54	$217.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $201.70 / $201.70 / $201.70	Facility		$201.70	$201.70	$201.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.31 / $43.31 / $43.31	Facility	26	$43.31	$43.31	$43.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.88 / $242.15 / $512.61	Professional		$176.88	$242.15	$512.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.46 / $45.41 / $104.98	Professional	26	$33.46	$45.41	$104.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.34 / $192.93 / $411.08	Professional	TC	$139.34	$192.93	$411.08
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $207.92 / $658.07 / $917.24	Facility		$207.92	$658.07	$917.24
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $32.84 / $45.06 / $56.77	Facility	26	$32.84	$45.06	$56.77
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $185.58 / $236.68 / $321.02	Professional		$185.58	$236.68	$321.02
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $32.84 / $45.06 / $73.20	Professional	26	$32.84	$45.06	$73.20
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $149.38 / $188.88 / $250.72	Professional	TC	$149.38	$188.88	$250.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $144.78 / $215.89	Professional		$36.43	$144.78	$215.89
United Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $118.38 / $182.69	Facility		$29.51	$118.38	$182.69
United Facility/Professional Professional Modifier Low / Median / High Price $191.70 / $236.25 / $309.42	Professional		$191.70	$236.25	$309.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $41.35 / $65.70	Professional	26	$33.54	$41.35	$65.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.99 / $198.56 / $265.27	Professional	TC	$150.99	$198.56	$265.27