Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.77 / $136.88 / $377.12	Facility		$52.77	$136.88	$377.12
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 $36.36 / $105.11 / $261.89	Facility	TC	$36.36	$105.11	$261.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.18 / $50.16 / $130.50	Professional		$27.18	$50.16	$130.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.63 / $11.06 / $49.65	Professional	26	$7.63	$11.06	$49.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $44.56 / $238.24 / $299.48	Professional	50	$44.56	$238.24	$299.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.38 / $36.79 / $95.95	Professional	TC	$25.38	$36.79	$95.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.70 / $34.10 / $46.04	Professional		$30.70	$34.10	$46.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.48 / $9.72 / $15.88	Professional	26	$6.48	$9.72	$15.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $46.05 / $46.05 / $55.80	Professional	50	$46.05	$46.05	$55.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.26 / $29.26 / $52.67	Professional	TC	$29.26	$29.26	$52.67
BCBS Facility/Professional Facility Modifier Low / Median / High Price $63.44 / $109.93 / $189.49	Facility		$63.44	$109.93	$189.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.85 / $74.09 / $137.36	Professional		$13.85	$74.09	$137.36
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 $112.27 / $132.08 / $132.08	Professional	50	$112.27	$132.08	$132.08
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.82 / $52.73 / $52.73	Professional	TC	$44.82	$52.73	$52.73
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.98 / $34.02 / $50.23	Facility		$7.98	$34.02	$50.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.90 / $36.72 / $52.35	Professional		$8.90	$36.72	$52.35
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.23 / $46.23 / $46.23	Facility		$46.23	$46.23	$46.23
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 $36.90 / $36.90 / $36.90	Facility	TC	$36.90	$36.90	$36.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.10 / $45.72 / $88.17	Professional		$30.10	$45.72	$88.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $10.60 / $20.59	Professional	26	$6.55	$10.60	$20.59
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.61 / $47.36 / $55.21	Professional	50	$35.61	$47.36	$55.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.61 / $35.25 / $69.79	Professional	TC	$22.61	$35.25	$69.79
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $52.77 / $166.25 / $396.94	Facility		$52.77	$166.25	$396.94
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 $36.36 / $85.92 / $293.55	Facility	TC	$36.36	$85.92	$293.55
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $30.04 / $47.91 / $115.42	Professional		$30.04	$47.91	$115.42
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.82 / $10.11 / $41.36	Professional	26	$6.82	$10.11	$41.36
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $50.51 / $96.00 / $238.24	Professional	50	$50.51	$96.00	$238.24
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $23.23 / $36.36 / $71.90	Professional	TC	$23.23	$36.36	$71.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.41 / $33.09 / $47.38	Professional		$26.41	$33.09	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $30.14 / $38.58 / $55.36	Professional		$30.14	$38.58	$55.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.90 / $9.36 / $14.47	Professional	26	$7.90	$9.36	$14.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.21 / $28.80 / $40.89	Professional	TC	$22.21	$28.80	$40.89