Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $34.97 / $125.27 / $299.05	Facility		$34.97	$125.27	$299.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.16 / $9.16 / $9.61	Facility	26	$9.16	$9.16	$9.61
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.14 / $24.15 / $137.07	Facility	TC	$24.14	$24.15	$137.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.30 / $33.45 / $79.73	Professional		$24.30	$33.45	$79.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $9.61 / $35.79	Professional	26	$7.03	$9.61	$35.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $24.15 / $39.47	Professional	TC	$18.21	$24.15	$39.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.10 / $26.56 / $35.79	Professional		$23.10	$26.56	$35.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.82 / $7.66 / $14.54	Professional	26	$5.82	$7.66	$14.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.23 / $19.23 / $34.63	Professional	TC	$19.23	$19.23	$34.63
BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.72 / $60.81 / $131.15	Facility		$40.72	$60.81	$131.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.74 / $46.01 / $97.49	Professional		$12.74	$46.01	$97.49
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $12.25 / $12.25	Professional	26	$10.41	$12.25	$12.25
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 $29.43 / $34.61 / $34.61	Professional	TC	$29.43	$34.61	$34.61
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.34 / $22.37 / $35.86	Facility		$7.34	$22.37	$35.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.19 / $24.95 / $37.18	Professional		$8.19	$24.95	$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 $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $24.24 / $24.24 / $24.24	Facility	TC	$24.24	$24.24	$24.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.24 / $33.11 / $62.62	Professional		$23.24	$33.11	$62.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.30 / $9.74 / $19.75	Professional	26	$6.30	$9.74	$19.75
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.68 / $39.11 / $41.71	Professional	50	$29.68	$39.11	$41.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.93 / $23.57 / $45.70	Professional	TC	$15.93	$23.57	$45.70
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $33.81 / $146.34 / $305.37	Facility		$33.81	$146.34	$305.37
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.29 / $9.16 / $9.61	Facility	26	$6.29	$9.16	$9.61
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $24.14 / $31.46 / $167.76	Facility	TC	$24.14	$31.46	$167.76
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $22.37 / $33.31 / $72.28	Professional		$22.37	$33.31	$72.28
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.29 / $9.17 / $27.20	Professional	26	$6.29	$9.17	$27.20
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.07 / $24.14 / $38.04	Professional	TC	$16.07	$24.14	$38.04
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 Facility Modifier Low / Median / High Price $80.90 / $80.90 / $80.90	Facility		$80.90	$80.90	$80.90
United Facility/Professional Professional Modifier Low / Median / High Price $24.85 / $29.25 / $87.90	Professional		$24.85	$29.25	$87.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.26 / $8.88 / $13.32	Professional	26	$7.26	$8.88	$13.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.11 / $20.23 / $29.14	Professional	TC	$17.11	$20.23	$29.14