Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.90 / $127.37 / $401.92	Facility		$47.90	$127.37	$401.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.93 / $9.93 / $12.52	Facility	26	$9.93	$9.93	$12.52
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.92 / $57.92 / $240.51	Facility	TC	$31.92	$57.92	$240.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.42 / $44.96 / $111.60	Professional		$26.42	$44.96	$111.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.53 / $11.14 / $50.40	Professional	26	$7.53	$11.14	$50.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $55.80 / $112.99 / $122.54	Professional	50	$55.80	$112.99	$122.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.34 / $20.94 / $20.94	Professional	52	$12.34	$20.94	$20.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.77 / $35.54 / $83.13	Professional	TC	$23.77	$35.54	$83.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.86 / $32.78 / $45.93	Professional		$27.86	$32.78	$45.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.48 / $8.30 / $15.80	Professional	26	$6.48	$8.30	$15.80
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $45.05 / $45.05 / $45.05	Professional	50	$45.05	$45.05	$45.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.01 / $44.71 / $44.71	Professional	TC	$38.01	$44.71	$44.71
BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.05 / $93.72 / $169.48	Facility		$54.05	$93.72	$169.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.00 / $58.05 / $124.83	Professional		$17.00	$58.05	$124.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.32 / $13.32 / $13.32	Professional	26	$11.32	$13.32	$13.32
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $98.69 / $116.10 / $116.10	Professional	50	$98.69	$116.10	$116.10
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.03 / $44.74 / $44.74	Professional	TC	$38.03	$44.74	$44.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.98 / $28.88 / $44.27	Facility		$7.98	$28.88	$44.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.90 / $31.46 / $46.04	Professional		$8.90	$31.46	$46.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.01 / $41.01 / $41.01	Facility		$41.01	$41.01	$41.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $31.68 / $31.68 / $31.68	Facility	TC	$31.68	$31.68	$31.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.26 / $41.21 / $77.55	Professional		$28.26	$41.21	$77.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $10.60 / $20.59	Professional	26	$6.55	$10.60	$20.59
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.33 / $43.30 / $49.34	Professional	50	$34.33	$43.30	$49.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.46 / $32.33 / $59.16	Professional	TC	$20.46	$32.33	$59.16
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $46.34 / $145.86 / $386.65	Facility		$46.34	$145.86	$386.65
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.82 / $9.93 / $10.43	Facility	26	$6.82	$9.93	$10.43
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $31.92 / $75.43 / $266.29	Facility	TC	$31.92	$75.43	$266.29
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $26.87 / $43.33 / $96.36	Professional		$26.87	$43.33	$96.36
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.82 / $10.25 / $47.00	Professional	26	$6.82	$10.25	$47.00
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $46.56 / $91.28 / $122.54	Professional	50	$46.56	$91.28	$122.54
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $16.05 / $20.94 / $49.81	Professional	52	$16.05	$20.94	$49.81
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.05 / $31.93 / $67.02	Professional	TC	$20.05	$31.93	$67.02
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 Facility Modifier Low / Median / High Price $30.98 / $47.66 / $80.90	Facility		$30.98	$47.66	$80.90
United Facility/Professional Professional Modifier Low / Median / High Price $28.36 / $34.40 / $49.70	Professional		$28.36	$34.40	$49.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.81 / $9.28 / $14.47	Professional	26	$7.81	$9.28	$14.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.83 / $25.08 / $35.18	Professional	TC	$20.83	$25.08	$35.18