Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.24 / $129.60 / $304.72	Facility		$39.24	$129.60	$304.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.93 / $9.93 / $10.43	Facility	26	$9.93	$9.93	$10.43
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.10 / $40.67 / $189.32	Facility	TC	$27.10	$40.67	$189.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.20 / $44.45 / $101.80	Professional		$25.20	$44.45	$101.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $9.94 / $34.61	Professional	26	$7.33	$9.94	$34.61
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $79.14 / $79.14 / $93.00	Professional	50	$79.14	$79.14	$93.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.62 / $28.79 / $74.09	Professional	TC	$22.62	$28.79	$74.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.37 / $27.05 / $41.37	Professional		$24.37	$27.05	$41.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.48 / $8.30 / $15.80	Professional	26	$6.48	$8.30	$15.80
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $36.56 / $40.57 / $40.57	Professional	50	$36.56	$40.57	$40.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $33.04 / $33.04	Professional	TC	$33.04	$33.04	$33.04
BCBS Facility/Professional Facility Modifier Low / Median / High Price $47.17 / $77.76 / $159.93	Facility		$47.17	$77.76	$159.93
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.23 / $51.24 / $117.12	Professional		$13.23	$51.24	$117.12
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.32 / $13.32 / $13.32	Professional	26	$11.32	$13.32	$13.32
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $88.72 / $104.38 / $104.38	Professional	50	$88.72	$104.38	$104.38
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $38.88 / $38.88	Professional	TC	$33.04	$38.88	$38.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.98 / $25.12 / $39.90	Facility		$7.98	$25.12	$39.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.90 / $28.02 / $41.41	Professional		$8.90	$28.02	$41.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $36.90 / $36.90 / $36.90	Facility		$36.90	$36.90	$36.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.90 / $41.46 / $69.76	Professional		$27.90	$41.46	$69.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $10.34 / $20.59	Professional	26	$6.55	$10.34	$20.59
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.61 / $43.94 / $55.21	Professional	50	$35.61	$43.94	$55.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.17 / $29.58 / $56.70	Professional	TC	$20.17	$29.58	$56.70
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $37.71 / $150.15 / $324.16	Facility		$37.71	$150.15	$324.16
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.82 / $9.93 / $10.43	Facility	26	$6.82	$9.93	$10.43
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $27.10 / $50.15 / $195.29	Facility	TC	$27.10	$50.15	$195.29
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $27.40 / $38.18 / $91.56	Professional		$27.40	$38.18	$91.56
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.82 / $9.94 / $26.00	Professional	26	$6.82	$9.94	$26.00
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $79.14 / $93.00 / $208.00	Professional	50	$79.14	$93.00	$208.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.58 / $27.11 / $50.30	Professional	TC	$20.58	$27.11	$50.30
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 $28.96 / $35.11 / $48.82	Professional		$28.96	$35.11	$48.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.85 / $9.36 / $14.47	Professional	26	$7.85	$9.36	$14.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $25.87 / $37.56	Professional	TC	$20.39	$25.87	$37.56