Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.34 / $137.38 / $356.24	Facility		$46.34	$137.38	$356.24
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 $31.92 / $120.00 / $227.14	Facility	TC	$31.92	$120.00	$227.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.42 / $43.96 / $111.15	Professional		$26.42	$43.96	$111.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.44 / $10.43 / $48.06	Professional	26	$7.44	$10.43	$48.06
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $55.20 / $64.50 / $114.57	Professional	50	$55.20	$64.50	$114.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.77 / $34.38 / $88.66	Professional	TC	$23.77	$34.38	$88.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.52 / $36.29 / $47.18	Professional		$28.52	$36.29	$47.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.48 / $8.94 / $15.88	Professional	26	$6.48	$8.94	$15.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $41.67 / $46.27 / $54.44	Professional	50	$41.67	$46.27	$54.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $39.35 / $46.30 / $46.30	Professional	TC	$39.35	$46.30	$46.30
BCBS Facility/Professional Facility Modifier Low / Median / High Price $53.84 / $96.61 / $167.81	Facility		$53.84	$96.61	$167.81
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.45 / $59.65 / $117.13	Professional		$12.45	$59.65	$117.13
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 $101.41 / $119.30 / $119.30	Professional	50	$101.41	$119.30	$119.30
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.39 / $46.34 / $46.34	Professional	TC	$39.39	$46.34	$46.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.98 / $29.92 / $45.46	Facility		$7.98	$29.92	$45.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.90 / $32.29 / $47.31	Professional		$8.90	$32.29	$47.31
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.75 / $41.75 / $41.75	Facility		$41.75	$41.75	$41.75
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 $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.53 / $40.99 / $79.67	Professional		$27.53	$40.99	$79.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $10.66 / $20.59	Professional	26	$6.55	$10.66	$20.59
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.33 / $43.30 / $49.18	Professional	50	$34.33	$43.30	$49.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.85 / $31.37 / $61.29	Professional	TC	$19.85	$31.37	$61.29
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $46.34 / $175.53 / $443.63	Facility		$46.34	$175.53	$443.63
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.82 / $9.93 / $10.19	Facility	26	$6.82	$9.93	$10.19
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $31.92 / $75.43 / $227.14	Facility	TC	$31.92	$75.43	$227.14
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $26.08 / $42.09 / $101.80	Professional		$26.08	$42.09	$101.80
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.82 / $10.05 / $45.92	Professional	26	$6.82	$10.05	$45.92
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $46.01 / $69.78 / $111.78	Professional	50	$46.01	$69.78	$111.78
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $19.26 / $31.92 / $66.28	Professional	TC	$19.26	$31.92	$66.28
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 $30.98 / $80.90 / $80.90	Facility		$30.98	$80.90	$80.90
United Facility/Professional Professional Modifier Low / Median / High Price $27.56 / $33.60 / $48.28	Professional		$27.56	$33.60	$48.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.85 / $9.28 / $14.47	Professional	26	$7.85	$9.28	$14.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.76 / $25.03 / $34.75	Professional	TC	$19.76	$25.03	$34.75