Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $136.90 / $203.26 / $528.11	Facility		$136.90	$203.26	$528.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.45 / $45.45 / $57.26	Facility	26	$45.45	$45.45	$57.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $149.21 / $201.00 / $250.14	Professional		$149.21	$201.00	$250.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.94 / $54.92 / $90.86	Professional	26	$41.94	$54.92	$90.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.58 / $146.08 / $187.46	Professional	TC	$104.58	$146.08	$187.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $116.32 / $124.44 / $143.69	Professional		$116.32	$124.44	$143.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.59 / $48.40 / $51.11	Professional	26	$36.59	$48.40	$51.11
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $31.11 / $31.11 / $31.11	Professional	52	$31.11	$31.11	$31.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $173.02 / $385.63 / $789.81	Facility		$173.02	$385.63	$789.81
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.33 / $164.37 / $233.58	Professional		$53.33	$164.37	$233.58
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.06 / $61.25 / $61.25	Professional	26	$52.06	$61.25	$61.25
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $143.80 / $143.80 / $143.80	Professional	TC	$143.80	$143.80	$143.80
CareSource Facility/Professional Facility Modifier Low / Median / High Price $40.10 / $103.53 / $162.53	Facility		$40.10	$103.53	$162.53
CareSource Facility/Professional Professional Modifier Low / Median / High Price $41.45 / $100.30 / $158.85	Professional		$41.45	$100.30	$158.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.35 / $268.19 / $360.76	Professional		$123.35	$268.19	$360.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.25 / $79.19 / $99.58	Professional	26	$37.25	$79.19	$99.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.21 / $188.88 / $240.21	Professional	TC	$93.21	$188.88	$240.21
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $153.30 / $227.34 / $528.11	Facility		$153.30	$227.34	$528.11
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $45.45 / $49.43 / $57.26	Facility	26	$45.45	$49.43	$57.26
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $140.96 / $161.32 / $239.12	Professional		$140.96	$161.32	$239.12
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $42.03 / $49.43 / $72.31	Professional	26	$42.03	$49.43	$72.31
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $99.34 / $115.86 / $169.35	Professional	TC	$99.34	$115.86	$169.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.83 / $110.69 / $167.46	Professional		$35.83	$110.69	$167.46
United Facility/Professional Professional Modifier Low / Median / High Price $161.69 / $211.96 / $285.76	Professional		$161.69	$211.96	$285.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.59 / $59.38 / $82.85	Professional	26	$42.59	$59.38	$82.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.47 / $146.96 / $200.83	Professional	TC	$117.47	$146.96	$200.83