Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $32.20 / $97.29 / $212.88	Facility		$32.20	$97.29	$212.88
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.80 / $8.80 / $9.24	Facility	26	$8.80	$8.80	$9.24
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.41 / $23.97 / $194.08	Facility	TC	$23.41	$23.97	$194.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.62 / $32.20 / $84.04	Professional		$24.62	$32.20	$84.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.71 / $8.80 / $38.36	Professional	26	$6.71	$8.80	$38.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.61 / $16.10 / $16.42	Professional	52	$9.61	$16.10	$16.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $23.41 / $43.31	Professional	TC	$17.89	$23.41	$43.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.59 / $23.52 / $27.67	Professional		$18.59	$23.52	$27.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.74 / $8.60 / $14.45	Professional	26	$5.74	$8.60	$14.45
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $35.17 / $41.51 / $41.51	Professional	50	$35.17	$41.51	$41.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.64 / $18.64 / $20.32	Professional	TC	$18.64	$18.64	$20.32
BCBS Facility/Professional Facility Modifier Low / Median / High Price $37.44 / $67.09 / $120.57	Facility		$37.44	$67.09	$120.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.50 / $42.33 / $94.16	Professional		$10.50	$42.33	$94.16
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.96 / $11.72 / $11.72	Professional	26	$9.96	$11.72	$11.72
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $76.95 / $90.54 / $90.54	Professional	50	$76.95	$90.54	$90.54
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.52 / $33.54 / $33.54	Professional	TC	$28.52	$33.54	$33.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.03 / $21.68 / $34.68	Facility		$7.03	$21.68	$34.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.84 / $24.18 / $35.90	Professional		$7.84	$24.18	$35.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.07 / $32.07 / $32.07	Facility		$32.07	$32.07	$32.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $8.51 / $8.51	Facility	26	$8.51	$8.51	$8.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.71 / $33.00 / $60.49	Professional		$22.71	$33.00	$60.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.74 / $9.58 / $18.27	Professional	26	$5.74	$9.58	$18.27
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.63 / $38.08 / $41.71	Professional	50	$28.63	$38.08	$41.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.53 / $24.65 / $46.74	Professional	TC	$16.53	$24.65	$46.74
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $32.20 / $104.19 / $233.06	Facility		$32.20	$104.19	$233.06
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.02 / $8.80 / $9.02	Facility	26	$6.02	$8.80	$9.02
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $23.41 / $30.49 / $162.63	Facility	TC	$23.41	$30.49	$162.63
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $22.11 / $32.20 / $69.87	Professional		$22.11	$32.20	$69.87
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.02 / $8.80 / $21.76	Professional	26	$6.02	$8.80	$21.76
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $76.58 / $76.58 / $76.58	Professional	50	$76.58	$76.58	$76.58
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $12.28 / $16.10 / $27.65	Professional	52	$12.28	$16.10	$27.65
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.07 / $23.41 / $39.29	Professional	TC	$16.07	$23.41	$39.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $32.80 / $45.08	Professional		$26.17	$32.80	$45.08
United Facility/Professional Professional Modifier Low / Median / High Price $23.42 / $28.30 / $41.70	Professional		$23.42	$28.30	$41.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.14 / $8.55 / $12.79	Professional	26	$7.14	$8.55	$12.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.25 / $20.01 / $28.04	Professional	TC	$16.25	$20.01	$28.04