Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.27 / $122.89 / $368.07	Facility		$48.27	$122.89	$368.07
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $10.72 / $13.50	Facility	26	$10.72	$10.72	$13.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $35.25 / $136.80 / $300.30	Facility	TC	$35.25	$136.80	$300.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.00 / $52.87 / $147.41	Professional		$33.00	$52.87	$147.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $11.25 / $55.31	Professional	26	$8.56	$11.25	$55.31
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $47.07 / $101.09 / $137.94	Professional	50	$47.07	$101.09	$137.94
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.59 / $22.99 / $22.99	Professional	52	$13.59	$22.99	$22.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $35.26 / $96.90	Professional	TC	$24.44	$35.26	$96.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.23 / $36.64 / $45.30	Professional		$30.23	$36.64	$45.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.98 / $10.74 / $17.12	Professional	26	$6.98	$10.74	$17.12
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $45.34 / $45.34 / $59.22	Professional	50	$45.34	$45.34	$59.22
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.02 / $30.54 / $50.54	Professional	TC	$28.02	$30.54	$50.54
BCBS Facility/Professional Facility Modifier Low / Median / High Price $60.25 / $101.20 / $177.76	Facility		$60.25	$101.20	$177.76
BCBS Facility/Professional Professional Modifier Low / Median / High Price $14.29 / $64.98 / $133.66	Professional		$14.29	$64.98	$133.66
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.22 / $14.38 / $14.38	Professional	26	$12.22	$14.38	$14.38
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $110.47 / $129.96 / $129.96	Professional	50	$110.47	$129.96	$129.96
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.01 / $50.60 / $50.60	Professional	TC	$43.01	$50.60	$50.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.61 / $32.65 / $49.49	Facility		$8.61	$32.65	$49.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.63 / $35.24 / $51.55	Professional		$9.63	$35.24	$51.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $45.85 / $45.85 / $45.85	Facility		$45.85	$45.85	$45.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.79 / $35.79 / $35.79	Facility	TC	$35.79	$35.79	$35.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.08 / $46.81 / $86.82	Professional		$31.08	$46.81	$86.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.37 / $11.60 / $22.41	Professional	26	$7.37	$11.60	$22.41
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $37.47 / $48.26 / $55.21	Professional	50	$37.47	$48.26	$55.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $35.76 / $66.95	Professional	TC	$22.51	$35.76	$66.95
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $46.80 / $144.57 / $368.07	Facility		$46.80	$144.57	$368.07
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.27 / $10.72 / $13.50	Facility	26	$8.27	$10.72	$13.50
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $35.25 / $83.30 / $293.30	Facility	TC	$35.25	$83.30	$293.30
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $30.45 / $49.26 / $117.90	Professional		$30.45	$49.26	$117.90
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.27 / $10.72 / $46.55	Professional	26	$8.27	$10.72	$46.55
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $47.07 / $103.15 / $137.94	Professional	50	$47.07	$103.15	$137.94
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $17.80 / $22.99 / $55.01	Professional	52	$17.80	$22.99	$55.01
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $22.17 / $35.25 / $74.14	Professional	TC	$22.17	$35.25	$74.14
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 Professional Modifier Low / Median / High Price $31.82 / $39.00 / $66.56	Professional		$31.82	$39.00	$66.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.53 / $10.46 / $15.30	Professional	26	$8.53	$10.46	$15.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.42 / $28.46 / $40.34	Professional	TC	$22.42	$28.46	$40.34