Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.76 / $104.12 / $265.10	Facility		$43.76	$104.12	$265.10
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.34 / $10.34 / $10.86	Facility	26	$10.34	$10.34	$10.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.07 / $31.57 / $194.08	Facility	TC	$30.07	$31.57	$194.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.72 / $40.42 / $114.53	Professional		$27.72	$40.42	$114.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.34 / $10.35 / $38.95	Professional	26	$8.34	$10.35	$38.95
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $79.00 / $79.00 / $79.00	Professional	50	$79.00	$79.00	$79.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $30.07 / $50.05	Professional	TC	$20.96	$30.07	$50.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.58 / $28.07 / $39.82	Professional		$26.58	$28.07	$39.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $8.64 / $14.00	Professional	26	$6.92	$8.64	$14.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.07 / $26.07 / $26.07	Professional	TC	$26.07	$26.07	$26.07
BCBS Facility/Professional Facility Modifier Low / Median / High Price $49.38 / $81.70 / $151.55	Facility		$49.38	$81.70	$151.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.60 / $53.29 / $111.90	Professional		$13.60	$53.29	$111.90
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $13.85 / $13.85	Professional	26	$11.77	$13.85	$13.85
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $96.88 / $113.98 / $113.98	Professional	50	$96.88	$113.98	$113.98
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.67 / $43.14 / $43.14	Professional	TC	$36.67	$43.14	$43.14
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.31 / $27.85 / $43.53	Facility		$8.31	$27.85	$43.53
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.27 / $30.94 / $45.23	Professional		$9.27	$30.94	$45.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.89 / $39.89 / $39.89	Facility		$39.89	$39.89	$39.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $30.20 / $30.20	Facility	TC	$30.20	$30.20	$30.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.62 / $39.65 / $76.19	Professional		$26.62	$39.65	$76.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.22 / $21.44	Professional	26	$7.08	$11.22	$21.44
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.25 / $47.47 / $53.46	Professional	50	$35.25	$47.47	$53.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.37 / $29.43 / $57.03	Professional	TC	$20.37	$29.43	$57.03
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $41.14 / $125.79 / $265.10	Facility		$41.14	$125.79	$265.10
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $7.28 / $10.34 / $10.86	Facility	26	$7.28	$10.34	$10.86
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $30.07 / $45.11 / $208.56	Facility	TC	$30.07	$45.11	$208.56
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $24.34 / $40.42 / $71.84	Professional		$24.34	$40.42	$71.84
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.28 / $10.34 / $27.72	Professional	26	$7.28	$10.34	$27.72
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $79.00 / $87.78 / $87.78	Professional	50	$79.00	$87.78	$87.78
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $17.05 / $30.07 / $46.22	Professional	TC	$17.05	$30.07	$46.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $33.05 / $47.38	Professional		$26.31	$33.05	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $29.52 / $35.58 / $51.05	Professional		$29.52	$35.58	$51.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.52 / $10.34 / $14.40	Professional	26	$8.52	$10.34	$14.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.67 / $24.87 / $35.44	Professional	TC	$20.67	$24.87	$35.44