Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.08 / $13.08 / $13.74	Facility	26	$13.08	$13.08	$13.74
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $39.71 / $59.57 / $242.17	Facility	TC	$39.71	$59.57	$242.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.90 / $57.00 / $144.40	Professional		$37.90	$57.00	$144.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $13.74 / $62.40	Professional	26	$10.02	$13.74	$62.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $41.93 / $109.72 / $382.50	Professional	50	$41.93	$109.72	$382.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.41 / $26.40 / $26.40	Professional	52	$15.41	$26.40	$26.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $43.15 / $109.34	Professional	TC	$27.87	$43.15	$109.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.15 / $42.65 / $52.73	Professional		$35.15	$42.65	$52.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.88 / $15.66	Professional	26	$8.32	$10.88	$15.66
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $52.73 / $58.50 / $63.98	Professional	50	$52.73	$58.50	$63.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.75 / $49.27 / $52.34	Professional	TC	$43.75	$49.27	$52.34
BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.26 / $75.66 / $155.57	Professional		$17.26	$75.66	$155.57
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.94 / $17.57 / $17.57	Professional	26	$14.94	$17.57	$17.57
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $128.57 / $151.26 / $151.26	Professional	50	$128.57	$151.26	$151.26
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $49.34 / $58.05 / $58.05	Professional	TC	$49.34	$58.05	$58.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.79 / $40.88 / $60.09	Professional		$11.79	$40.88	$60.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.66 / $12.66 / $12.66	Facility	26	$12.66	$12.66	$12.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $40.63 / $40.63 / $40.63	Facility	TC	$40.63	$40.63	$40.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.84 / $52.25 / $101.23	Professional		$35.84	$52.25	$101.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $14.05 / $26.70	Professional	26	$8.64	$14.05	$26.70
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $41.84 / $54.25 / $64.62	Professional	50	$41.84	$54.25	$64.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.52 / $40.08 / $76.87	Professional	TC	$25.52	$40.08	$76.87
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $9.86 / $13.08 / $13.74	Facility	26	$9.86	$13.08	$13.74
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $39.71 / $73.45 / $280.00	Facility	TC	$39.71	$73.45	$280.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $35.47 / $53.31 / $116.62	Professional		$35.47	$53.31	$116.62
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.86 / $13.09 / $53.60	Professional	26	$9.86	$13.09	$53.60
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $22.40 / $95.16 / $159.22	Professional	50	$22.40	$95.16	$159.22
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $20.14 / $26.40 / $61.95	Professional	52	$20.14	$26.40	$61.95
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $25.61 / $39.71 / $82.00	Professional	TC	$25.61	$39.71	$82.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $33.09 / $47.38	Professional		$26.52	$33.09	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $35.72 / $43.31 / $63.94	Professional		$35.72	$43.31	$63.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.11 / $12.70 / $18.17	Professional	26	$10.11	$12.70	$18.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.07 / $31.20 / $43.63	Professional	TC	$26.07	$31.20	$43.63