Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.24 / $127.31 / $300.45	Facility		$39.24	$127.31	$300.45
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.16 / $9.16 / $9.61	Facility	26	$9.16	$9.16	$9.61
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.73 / $40.11 / $195.29	Facility	TC	$26.73	$40.11	$195.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.92 / $37.08 / $94.50	Professional		$24.92	$37.08	$94.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $9.17 / $43.02	Professional	26	$7.33	$9.17	$43.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $55.28 / $94.79 / $259.50	Professional	50	$55.28	$94.79	$259.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $26.74 / $55.71	Professional	TC	$17.57	$26.74	$55.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.63 / $28.62 / $38.58	Professional		$23.63	$28.62	$38.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.98 / $8.22 / $15.51	Professional	26	$5.98	$8.22	$15.51
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $35.44 / $35.44 / $35.44	Professional	50	$35.44	$35.44	$35.44
BCBS Facility/Professional Facility Modifier Low / Median / High Price $46.14 / $83.56 / $145.28	Facility		$46.14	$83.56	$145.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.45 / $49.68 / $108.81	Professional		$11.45	$49.68	$108.81
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $12.25 / $12.25	Professional	26	$10.41	$12.25	$12.25
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $86.02 / $101.20 / $101.20	Professional	50	$86.02	$101.20	$101.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.60 / $38.35 / $38.35	Professional	TC	$32.60	$38.35	$38.35
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.34 / $24.77 / $38.65	Facility		$7.34	$24.77	$38.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.19 / $27.51 / $40.11	Professional		$8.19	$27.51	$40.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.40 / $35.40 / $35.40	Facility		$35.40	$35.40	$35.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.85 / $26.85 / $26.85	Facility	TC	$26.85	$26.85	$26.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.88 / $36.19 / $67.56	Professional		$23.88	$36.19	$67.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.30 / $9.97 / $19.01	Professional	26	$6.30	$9.97	$19.01
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.34 / $39.65 / $43.42	Professional	50	$30.34	$39.65	$43.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.20 / $26.75 / $50.66	Professional	TC	$16.20	$26.75	$50.66
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $36.54 / $151.52 / $304.67	Facility		$36.54	$151.52	$304.67
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.82 / $9.16 / $9.40	Facility	26	$6.82	$9.16	$9.40
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $26.73 / $48.75 / $185.60	Facility	TC	$26.73	$48.75	$185.60
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $22.37 / $35.90 / $77.92	Professional		$22.37	$35.90	$77.92
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.82 / $9.17 / $36.02	Professional	26	$6.82	$9.17	$36.02
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $55.28 / $94.79 / $259.50	Professional	50	$55.28	$94.79	$259.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $15.56 / $26.73 / $44.96	Professional	TC	$15.56	$26.73	$44.96
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 $25.07 / $29.54 / $44.96	Professional		$25.07	$29.54	$44.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.62 / $9.19 / $13.88	Professional	26	$7.62	$9.19	$13.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.60 / $21.60 / $31.08	Professional	TC	$17.60	$21.60	$31.08