Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.00 / $122.82 / $297.81	Facility		$44.00	$122.82	$297.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.57 / $9.57 / $12.05	Facility	26	$9.57	$9.57	$12.05
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.32 / $177.20 / $338.76	Facility	TC	$29.32	$177.20	$338.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $45.88 / $116.12	Professional		$25.00	$45.88	$116.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $10.81 / $50.00	Professional	26	$7.33	$10.81	$50.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $49.86 / $82.23 / $121.31	Professional	50	$49.86	$82.23	$121.31
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.55 / $19.46 / $19.46	Professional	52	$11.55	$19.46	$19.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.83 / $34.61 / $86.54	Professional	TC	$22.83	$34.61	$86.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.03 / $30.72 / $37.97	Professional		$26.03	$30.72	$37.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.23 / $8.60 / $15.72	Professional	26	$6.23	$8.60	$15.72
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $42.20 / $49.65	Professional	50	$38.02	$42.20	$49.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.07 / $25.11 / $41.53	Professional	TC	$23.07	$25.11	$41.53
BCBS Facility/Professional Facility Modifier Low / Median / High Price $45.25 / $83.08 / $170.87	Facility		$45.25	$83.08	$170.87
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.95 / $52.43 / $106.68	Professional		$11.95	$52.43	$106.68
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.86 / $12.78 / $12.78	Professional	26	$10.86	$12.78	$12.78
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $92.36 / $108.66 / $108.66	Professional	50	$92.36	$108.66	$108.66
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.31 / $41.54 / $41.54	Professional	TC	$35.31	$41.54	$41.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.67 / $26.83 / $41.48	Facility		$7.67	$26.83	$41.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.57 / $29.50 / $43.10	Professional		$8.57	$29.50	$43.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.40 / $38.40 / $38.40	Facility		$38.40	$38.40	$38.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.25 / $9.25 / $9.25	Facility	26	$9.25	$9.25	$9.25
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.46 / $29.46 / $29.46	Facility	TC	$29.46	$29.46	$29.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.20 / $38.63 / $72.59	Professional		$26.20	$38.63	$72.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.27 / $9.97 / $19.85	Professional	26	$6.27	$9.97	$19.85
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.46 / $43.30 / $48.75	Professional	50	$33.46	$43.30	$48.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.86 / $29.82 / $54.91	Professional	TC	$18.86	$29.82	$54.91
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $44.00 / $153.06 / $351.40	Facility		$44.00	$153.06	$351.40
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.55 / $9.57 / $12.05	Facility	26	$6.55	$9.57	$12.05
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $29.32 / $69.29 / $293.30	Facility	TC	$29.32	$69.29	$293.30
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $25.54 / $42.09 / $107.04	Professional		$25.54	$42.09	$107.04
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $9.82 / $47.69	Professional	26	$6.55	$9.82	$47.69
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $49.86 / $82.23 / $118.94	Professional	50	$49.86	$82.23	$118.94
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $15.04 / $19.46 / $45.75	Professional	52	$15.04	$19.46	$45.75
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.98 / $29.33 / $67.19	Professional	TC	$18.98	$29.33	$67.19
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 $80.90 / $80.90 / $80.90	Facility		$80.90	$80.90	$80.90
United Facility/Professional Professional Modifier Low / Median / High Price $27.24 / $32.75 / $47.57	Professional		$27.24	$32.75	$47.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.60 / $9.14 / $13.93	Professional	26	$7.60	$9.14	$13.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.69 / $23.31 / $34.60	Professional	TC	$19.69	$23.31	$34.60