Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.50 / $136.84 / $281.54	Facility		$38.50	$136.84	$281.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.52 / $9.52 / $12.02	Facility	26	$9.52	$9.52	$12.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.96 / $43.44 / $180.48	Facility	TC	$28.96	$43.44	$180.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.73 / $38.50 / $83.54	Professional		$27.73	$38.50	$83.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.66 / $9.53 / $29.92	Professional	26	$7.66	$9.53	$29.92
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.88 / $66.00 / $120.00	Professional	50	$52.88	$66.00	$120.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.43 / $19.25 / $54.56	Professional	52	$11.43	$19.25	$54.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $28.96 / $47.01	Professional	TC	$20.07	$28.96	$47.01
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.85 / $32.77 / $61.32	Professional		$27.85	$32.77	$61.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.41 / $8.56 / $13.93	Professional	26	$6.41	$8.56	$13.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.77 / $22.77 / $24.79	Professional	TC	$22.77	$22.77	$24.79
BCBS Facility/Professional Facility Modifier Low / Median / High Price $48.24 / $73.69 / $148.51	Facility		$48.24	$73.69	$148.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.13 / $55.32 / $111.88	Professional		$16.13	$55.32	$111.88
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 $91.44 / $107.58 / $107.58	Professional	50	$91.44	$107.58	$107.58
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 $7.66 / $26.48 / $41.03	Facility		$7.66	$26.48	$41.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.52 / $29.18 / $42.64	Professional		$8.52	$29.18	$42.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $38.02 / $38.02	Facility		$38.02	$38.02	$38.02
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 $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.24 / $38.65 / $71.81	Professional		$26.24	$38.65	$71.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.59 / $10.27 / $20.71	Professional	26	$6.59	$10.27	$20.71
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $31.50 / $41.47 / $47.09	Professional	50	$31.50	$41.47	$47.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.68 / $28.11 / $54.20	Professional	TC	$18.68	$28.11	$54.20
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $38.50 / $166.18 / $323.00	Facility		$38.50	$166.18	$323.00
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $7.75 / $9.52 / $10.01	Facility	26	$7.75	$9.52	$10.01
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $28.96 / $53.58 / $198.32	Facility	TC	$28.96	$53.58	$198.32
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $26.22 / $38.50 / $66.31	Professional		$26.22	$38.50	$66.31
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.75 / $9.53 / $22.93	Professional	26	$7.75	$9.53	$22.93
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $66.00 / $66.00 / $120.00	Professional	50	$66.00	$66.00	$120.00
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $14.48 / $19.25 / $82.74	Professional	52	$14.48	$19.25	$82.74
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.47 / $28.96 / $44.36	Professional	TC	$18.47	$28.96	$44.36
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 Professional Modifier Low / Median / High Price $25.33 / $31.72 / $46.83	Professional		$25.33	$31.72	$46.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.58 / $9.23 / $13.88	Professional	26	$7.58	$9.23	$13.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.75 / $23.31 / $34.61	Professional	TC	$17.75	$23.31	$34.61