Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.31 / $127.73 / $256.58	Facility		$33.31	$127.73	$256.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.52 / $9.52 / $10.01	Facility	26	$9.52	$9.52	$10.01
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.78 / $35.67 / $202.38	Facility	TC	$23.78	$35.67	$202.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.00 / $33.31 / $79.28	Professional		$23.00	$33.31	$79.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.74 / $9.53 / $37.75	Professional	26	$6.74	$9.53	$37.75
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.00 / $66.00 / $92.00	Professional	50	$66.00	$66.00	$92.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $23.78 / $51.60	Professional	TC	$18.82	$23.78	$51.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.34 / $28.63 / $53.52	Professional		$24.34	$28.63	$53.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.22 / $7.98 / $12.55	Professional	26	$6.22	$7.98	$12.55
BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.04 / $68.18 / $123.45	Facility		$38.04	$68.18	$123.45
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.13 / $46.87 / $93.79	Professional		$16.13	$46.87	$93.79
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.86 / $12.78 / $12.78	Professional	26	$10.86	$12.78	$12.78
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $79.68 / $93.74 / $93.74	Professional	50	$79.68	$93.74	$93.74
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.98 / $34.09 / $34.09	Professional	TC	$28.98	$34.09	$34.09
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.66 / $22.03 / $35.86	Facility		$7.66	$22.03	$35.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.52 / $24.57 / $37.18	Professional		$8.52	$24.57	$37.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.79 / $32.79 / $32.79	Facility		$32.79	$32.79	$32.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $33.71 / $62.62	Professional		$23.99	$33.71	$62.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.06 / $9.75 / $19.75	Professional	26	$6.06	$9.75	$19.75
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.16 / $38.60 / $42.30	Professional	50	$29.16	$38.60	$42.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.18 / $25.33 / $46.37	Professional	TC	$17.18	$25.33	$46.37
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $33.31 / $153.38 / $285.70	Facility		$33.31	$153.38	$285.70
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.29 / $9.52 / $10.01	Facility	26	$6.29	$9.52	$10.01
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $23.78 / $43.99 / $202.38	Facility	TC	$23.78	$43.99	$202.38
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $23.16 / $33.31 / $58.73	Professional		$23.16	$33.31	$58.73
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.29 / $9.52 / $31.00	Professional	26	$6.29	$9.52	$31.00
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $66.00 / $70.20 / $92.00	Professional	50	$66.00	$70.20	$92.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.88 / $23.78 / $39.92	Professional	TC	$16.88	$23.78	$39.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $32.80 / $45.08	Professional		$26.17	$32.80	$45.08
United Facility/Professional Facility Modifier Low / Median / High Price $29.40 / $38.54 / $80.90	Facility		$29.40	$38.54	$80.90
United Facility/Professional Professional Modifier Low / Median / High Price $24.06 / $29.09 / $43.21	Professional		$24.06	$29.09	$43.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.95 / $8.52 / $13.29	Professional	26	$6.95	$8.52	$13.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.11 / $20.53 / $30.32	Professional	TC	$17.11	$20.53	$30.32