Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.54 / $309.95 / $435.58	Facility		$46.54	$309.95	$435.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.43 / $37.20 / $44.64	Facility	26	$35.43	$37.20	$44.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.14 / $89.50 / $200.00	Professional		$55.14	$89.50	$200.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.15 / $46.76 / $133.63	Professional	26	$28.15	$46.76	$133.63
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $82.23 / $165.74 / $179.00	Professional	50	$82.23	$165.74	$179.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.57 / $32.97 / $57.87	Professional	TC	$15.57	$32.97	$57.87
BCBS Facility/Professional Facility Modifier Low / Median / High Price $30.75 / $56.46 / $99.17	Facility		$30.75	$56.46	$99.17
BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.00 / $76.16 / $155.50	Professional		$33.00	$76.16	$155.50
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $47.93 / $47.93	Professional	26	$40.74	$47.93	$47.93
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $152.32 / $152.32 / $152.32	Professional	50	$152.32	$152.32	$152.32
CareSource Facility/Professional Facility Modifier Low / Median / High Price $17.22 / $35.02 / $61.29	Facility		$17.22	$35.02	$61.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $17.30 / $36.54 / $59.17	Professional		$17.30	$36.54	$59.17
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.68 / $53.68 / $53.68	Facility		$53.68	$53.68	$53.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	26	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.37 / $91.37 / $170.25	Professional		$42.37	$91.37	$170.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.80 / $48.26 / $102.25	Professional	26	$25.80	$48.26	$102.25
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $79.23 / $90.51 / $132.16	Professional	50	$79.23	$90.51	$132.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.16 / $36.95 / $89.33	Professional	TC	$17.16	$36.95	$89.33
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $55.14 / $309.95 / $432.63	Facility		$55.14	$309.95	$432.63
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $35.43 / $41.55 / $44.64	Facility	26	$35.43	$41.55	$44.64
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $55.14 / $82.02 / $173.71	Professional		$55.14	$82.02	$173.71
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $31.92 / $41.55 / $132.59	Professional	26	$31.92	$41.55	$132.59
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $82.23 / $94.51 / $179.00	Professional	50	$82.23	$94.51	$179.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.84 / $31.70 / $53.49	Professional	TC	$18.84	$31.70	$53.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.23 / $44.27 / $78.81	Professional		$28.23	$44.27	$78.81
United Facility/Professional Facility Modifier Low / Median / High Price $108.97 / $108.97 / $108.97	Facility		$108.97	$108.97	$108.97
United Facility/Professional Professional Modifier Low / Median / High Price $51.08 / $97.24 / $133.75	Professional		$51.08	$97.24	$133.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.51 / $50.63 / $71.88	Professional	26	$30.51	$50.63	$71.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.30 / $40.72 / $60.43	Professional	TC	$19.30	$40.72	$60.43