Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.02 / $94.61 / $249.91	Facility		$37.02	$94.61	$249.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.52 / $9.52 / $10.01	Facility	26	$9.52	$9.52	$10.01
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.48 / $28.85 / $179.53	Facility	TC	$27.48	$28.85	$179.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.55 / $37.02 / $79.14	Professional		$25.55	$37.02	$79.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.94 / $9.52 / $21.76	Professional	26	$6.94	$9.52	$21.76
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.00 / $111.19 / $111.19	Professional	50	$30.00	$111.19	$111.19
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.98 / $18.51 / $18.51	Professional	52	$10.98	$18.51	$18.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.53 / $27.48 / $56.78	Professional	TC	$18.53	$27.48	$56.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.87 / $30.94 / $47.88	Professional		$23.87	$30.94	$47.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.67 / $7.66 / $12.06	Professional	26	$5.67	$7.66	$12.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.60 / $21.60 / $21.60	Professional	TC	$21.60	$21.60	$21.60
BCBS Facility/Professional Facility Modifier Low / Median / High Price $42.36 / $68.29 / $140.80	Facility		$42.36	$68.29	$140.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.74 / $57.37 / $106.35	Professional		$12.74	$57.37	$106.35
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 $86.92 / $102.26 / $102.26	Professional	50	$86.92	$102.26	$102.26
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $38.88 / $38.88	Professional	TC	$33.04	$38.88	$38.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.34 / $25.12 / $39.04	Facility		$7.34	$25.12	$39.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.19 / $27.79 / $40.54	Professional		$8.19	$27.79	$40.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $36.15 / $36.15 / $36.15	Facility		$36.15	$36.15	$36.15
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 $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.57 / $35.63 / $68.29	Professional		$24.57	$35.63	$68.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.30 / $9.82 / $19.75	Professional	26	$6.30	$9.82	$19.75
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.90 / $40.11 / $45.51	Professional	50	$29.90	$40.11	$45.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.20 / $27.89 / $51.36	Professional	TC	$17.20	$27.89	$51.36
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $37.02 / $128.80 / $274.48	Facility		$37.02	$128.80	$274.48
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.55 / $9.52 / $9.71	Facility	26	$6.55	$9.52	$9.71
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $27.48 / $41.22 / $188.16	Facility	TC	$27.48	$41.22	$188.16
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $23.43 / $37.02 / $59.30	Professional		$23.43	$37.02	$59.30
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $9.52 / $20.35	Professional	26	$6.55	$9.52	$20.35
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $48.70 / $79.58 / $111.19	Professional	50	$48.70	$79.58	$111.19
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $14.02 / $18.51 / $42.87	Professional	52	$14.02	$18.51	$42.87
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.88 / $27.48 / $45.59	Professional	TC	$16.88	$27.48	$45.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $32.77 / $44.83	Professional		$26.17	$32.77	$44.83
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 $25.54 / $30.51 / $46.60	Professional		$25.54	$30.51	$46.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.27 / $8.88 / $13.32	Professional	26	$7.27	$8.88	$13.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.07 / $21.88 / $31.21	Professional	TC	$18.07	$21.88	$31.21