Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.53 / $139.81 / $240.20	Facility		$35.53	$139.81	$240.20
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 $26.00 / $39.00 / $241.74	Facility	TC	$26.00	$39.00	$241.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.92 / $35.53 / $64.12	Professional		$24.92	$35.53	$64.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $9.52 / $28.42	Professional	26	$7.03	$9.52	$28.42
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $47.52 / $73.37 / $73.37	Professional	50	$47.52	$73.37	$73.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.53 / $17.77 / $17.77	Professional	52	$10.53	$17.77	$17.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $26.00 / $62.22	Professional	TC	$17.89	$26.00	$62.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.51 / $30.54 / $30.54	Professional		$20.51	$30.54	$30.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.90 / $7.80 / $10.77	Professional	26	$5.90	$7.80	$10.77
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $38.77 / $38.77 / $38.77	Professional	50	$38.77	$38.77	$38.77
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.56 / $22.56 / $22.56	Professional	TC	$22.56	$22.56	$22.56
BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.56 / $66.98 / $141.22	Facility		$40.56	$66.98	$141.22
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.55 / $50.06 / $100.16	Professional		$12.55	$50.06	$100.16
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 $85.10 / $100.12 / $100.12	Professional	50	$85.10	$100.12	$100.12
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.69 / $37.28 / $37.28	Professional	TC	$31.69	$37.28	$37.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.66 / $24.08 / $38.26	Facility		$7.66	$24.08	$38.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.52 / $26.87 / $39.71	Professional		$8.52	$26.87	$39.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.40 / $35.40 / $35.40	Facility		$35.40	$35.40	$35.40
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 $26.47 / $26.47 / $26.47	Facility	TC	$26.47	$26.47	$26.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.58 / $34.86 / $66.87	Professional		$23.58	$34.86	$66.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.30 / $9.93 / $19.75	Professional	26	$6.30	$9.93	$19.75
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.90 / $38.60 / $42.89	Professional	50	$29.90	$38.60	$42.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.20 / $25.32 / $49.25	Professional	TC	$16.20	$25.32	$49.25
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $35.53 / $153.90 / $241.74	Facility		$35.53	$153.90	$241.74
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.55 / $9.52 / $12.02	Facility	26	$6.55	$9.52	$12.02
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $26.00 / $52.00 / $226.84	Facility	TC	$26.00	$52.00	$226.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $22.63 / $35.53 / $56.65	Professional		$22.63	$35.53	$56.65
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $9.52 / $20.35	Professional	26	$6.55	$9.52	$20.35
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $47.52 / $73.37 / $111.18	Professional	50	$47.52	$73.37	$111.18
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $13.59 / $17.77 / $40.56	Professional	52	$13.59	$17.77	$40.56
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.07 / $26.00 / $43.69	Professional	TC	$16.07	$26.00	$43.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $32.77 / $44.83	Professional		$26.17	$32.77	$44.83
United Facility/Professional Facility Modifier Low / Median / High Price $108.97 / $108.97 / $108.97	Facility		$108.97	$108.97	$108.97
United Facility/Professional Professional Modifier Low / Median / High Price $25.42 / $29.15 / $41.15	Professional		$25.42	$29.15	$41.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.27 / $8.88 / $13.32	Professional	26	$7.27	$8.88	$13.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.11 / $20.92 / $29.28	Professional	TC	$17.11	$20.92	$29.28