Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.86 / $161.97 / $385.48	Facility		$46.86	$161.97	$385.48
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.72 / $12.72 / $16.02	Facility	26	$12.72	$12.72	$16.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.14 / $35.85 / $239.21	Facility	TC	$34.14	$35.85	$239.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.95 / $46.86 / $92.15	Professional		$35.95	$46.86	$92.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.19 / $12.72 / $32.29	Professional	26	$10.19	$12.72	$32.29
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.28 / $38.28 / $38.28	Professional	50	$38.28	$38.28	$38.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $34.14 / $53.05	Professional	TC	$25.57	$34.14	$53.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.14 / $40.14 / $40.14	Professional		$40.14	$40.14	$40.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.63 / $10.56 / $20.22	Professional	26	$8.63	$10.56	$20.22
BCBS Facility/Professional Facility Modifier Low / Median / High Price $51.32 / $72.98 / $126.86	Facility		$51.32	$72.98	$126.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $15.93 / $56.13 / $74.09	Professional		$15.93	$56.13	$74.09
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.48 / $17.04 / $17.04	Professional	26	$14.48	$17.04	$17.04
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.65 / $49.00 / $49.00	Professional	TC	$41.65	$49.00	$49.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.23 / $31.63 / $50.50	Facility		$10.23	$31.63	$50.50
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.45 / $35.29 / $52.52	Professional		$11.45	$35.29	$52.52
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 $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	TC	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.04 / $47.15 / $88.48	Professional		$31.04	$47.15	$88.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $13.65 / $26.30	Professional	26	$8.64	$13.65	$26.30
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $42.07 / $56.50 / $65.20	Professional	50	$42.07	$56.50	$65.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.42 / $34.15 / $64.83	Professional	TC	$23.42	$34.15	$64.83
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $46.86 / $171.60 / $422.60	Facility		$46.86	$171.60	$422.60
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.88 / $12.72 / $13.04	Facility	26	$8.88	$12.72	$13.04
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $34.14 / $51.23 / $236.64	Facility	TC	$34.14	$51.23	$236.64
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $29.63 / $46.86 / $77.00	Professional		$29.63	$46.86	$77.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.88 / $12.72 / $28.78	Professional	26	$8.88	$12.72	$28.78
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $38.28 / $38.28 / $38.29	Professional	50	$38.28	$38.28	$38.29
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.76 / $34.14 / $52.80	Professional	TC	$20.76	$34.14	$52.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $32.77 / $44.83	Professional		$26.31	$32.77	$44.83
United Facility/Professional Professional Modifier Low / Median / High Price $35.90 / $42.23 / $62.07	Professional		$35.90	$42.23	$62.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.40 / $12.66 / $19.05	Professional	26	$10.40	$12.66	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.13 / $29.57 / $43.30	Professional	TC	$25.13	$29.57	$43.30