Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.19 / $90.54 / $258.31	Facility		$43.19	$90.54	$258.31
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 $29.32 / $44.00 / $274.68	Facility	TC	$29.32	$44.00	$274.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.07 / $40.47 / $99.60	Professional		$23.07	$40.47	$99.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.53 / $45.96	Professional	26	$7.76	$9.53	$45.96
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.00 / $63.76 / $252.00	Professional	50	$30.00	$63.76	$252.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.55 / $19.44 / $19.44	Professional	52	$11.55	$19.44	$19.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $29.33 / $74.09	Professional	TC	$19.46	$29.33	$74.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.08 / $33.09 / $37.97	Professional		$26.08	$33.09	$37.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.06 / $7.98 / $12.55	Professional	26	$6.06	$7.98	$12.55
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $40.11 / $49.64 / $56.96	Professional	50	$40.11	$49.64	$56.96
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $25.11 / $25.11 / $25.11	Professional	TC	$25.11	$25.11	$25.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $49.46 / $90.51 / $170.87	Facility		$49.46	$90.51	$170.87
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.95 / $54.33 / $108.71	Professional		$11.95	$54.33	$108.71
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 $92.36 / $108.66 / $108.66	Professional	50	$92.36	$108.66	$108.66
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.31 / $41.54 / $41.54	Professional	TC	$35.31	$41.54	$41.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.66 / $26.83 / $41.44	Facility		$7.66	$26.83	$41.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.52 / $29.46 / $43.06	Professional		$8.52	$29.46	$43.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.40 / $38.40 / $38.40	Facility		$38.40	$38.40	$38.40
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 $29.46 / $29.46 / $29.46	Facility	TC	$29.46	$29.46	$29.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.46 / $38.42 / $72.54	Professional		$26.46	$38.42	$72.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.59 / $10.67 / $19.75	Professional	26	$6.59	$10.67	$19.75
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $31.54 / $41.91 / $47.61	Professional	50	$31.54	$41.91	$47.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.19 / $29.86 / $54.91	Professional	TC	$18.19	$29.86	$54.91
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $43.19 / $128.24 / $303.95	Facility		$43.19	$128.24	$303.95
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.02 / $9.52 / $10.01	Facility	26	$8.02	$9.52	$10.01
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $29.32 / $69.29 / $203.62	Facility	TC	$29.32	$69.29	$203.62
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $25.69 / $38.86 / $82.95	Professional		$25.69	$38.86	$82.95
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $9.53 / $24.42	Professional	26	$7.95	$9.53	$24.42
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $63.76 / $98.62 / $252.00	Professional	50	$63.76	$98.62	$252.00
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $14.89 / $19.44 / $42.50	Professional	52	$14.89	$19.44	$42.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $17.67 / $29.32 / $52.40	Professional	TC	$17.67	$29.32	$52.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $32.80 / $45.08	Professional		$26.17	$32.80	$45.08
United Facility/Professional Facility Modifier Low / Median / High Price $80.90 / $80.90 / $80.90	Facility		$80.90	$80.90	$80.90
United Facility/Professional Professional Modifier Low / Median / High Price $25.32 / $32.79 / $48.23	Professional		$25.32	$32.79	$48.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.90 / $9.67 / $45.30	Professional	26	$7.90	$9.67	$45.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.13 / $23.99 / $35.83	Professional	TC	$19.13	$23.99	$35.83