Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.81 / $146.29 / $399.33	Facility		$41.81	$146.29	$399.33
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $10.72 / $11.89	Facility	26	$10.72	$10.72	$11.89
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.58 / $177.90 / $240.51	Facility	TC	$28.58	$177.90	$240.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.71 / $42.73 / $104.40	Professional		$27.71	$42.73	$104.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $10.72 / $52.25	Professional	26	$8.56	$10.72	$52.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.86 / $77.56 / $117.94	Professional	50	$17.86	$77.56	$117.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $28.59 / $78.48	Professional	TC	$19.14	$28.59	$78.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.85 / $31.33 / $33.81	Professional		$25.85	$31.33	$33.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.18 / $10.74 / $17.12	Professional	26	$7.18	$10.74	$17.12
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $38.77 / $43.02 / $50.61	Professional	50	$38.77	$43.02	$50.61
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $24.79 / $24.79 / $30.99	Professional	TC	$24.79	$24.79	$30.99
BCBS Facility/Professional Facility Modifier Low / Median / High Price $46.94 / $73.69 / $148.51	Facility		$46.94	$73.69	$148.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.14 / $82.86 / $119.12	Professional		$16.14	$82.86	$119.12
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.22 / $14.38 / $14.38	Professional	26	$12.22	$14.38	$14.38
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $94.16 / $110.78 / $110.78	Professional	50	$94.16	$110.78	$110.78
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.86 / $41.01 / $41.01	Professional	TC	$34.86	$41.01	$41.01
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.61 / $26.48 / $42.34	Facility		$8.61	$26.48	$42.34
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.63 / $29.55 / $43.98	Professional		$9.63	$29.55	$43.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.14 / $39.14 / $39.14	Facility		$39.14	$39.14	$39.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.10 / $38.61 / $74.06	Professional		$26.10	$38.61	$74.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.37 / $11.60 / $22.41	Professional	26	$7.37	$11.60	$22.41
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.71 / $43.30 / $45.82	Professional	50	$33.71	$43.30	$45.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.53 / $27.91 / $54.20	Professional	TC	$17.53	$27.91	$54.20
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $42.89 / $177.90 / $408.69	Facility		$42.89	$177.90	$408.69
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.27 / $10.72 / $11.25	Facility	26	$8.27	$10.72	$11.25
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $28.58 / $94.05 / $269.58	Facility	TC	$28.58	$94.05	$269.58
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $25.42 / $40.79 / $85.90	Professional		$25.42	$40.79	$85.90
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.27 / $10.72 / $35.49	Professional	26	$8.27	$10.72	$35.49
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $17.86 / $77.56 / $113.04	Professional	50	$17.86	$77.56	$113.04
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $17.14 / $28.58 / $58.65	Professional	TC	$17.14	$28.58	$58.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $33.09 / $47.38	Professional		$26.31	$33.09	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $27.45 / $32.97 / $46.79	Professional		$27.45	$32.97	$46.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.33 / $10.36 / $15.08	Professional	26	$8.33	$10.36	$15.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.91 / $22.63 / $31.15	Professional	TC	$18.91	$22.63	$31.15