Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $99.77 / $200.06 / $615.00	Facility		$99.77	$200.06	$615.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.29 / $32.29 / $40.69	Facility	26	$32.29	$32.29	$40.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.52 / $131.09 / $330.12	Professional		$106.52	$131.09	$330.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $33.70 / $130.00	Professional	26	$24.07	$33.70	$130.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.09 / $63.23 / $63.99	Professional	52	$37.09	$63.23	$63.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.34 / $95.46 / $191.61	Professional	TC	$79.34	$95.46	$191.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.09 / $86.05 / $106.10	Professional		$77.09	$86.05	$106.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.35 / $26.62 / $52.26	Professional	26	$20.35	$26.62	$52.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.32 / $57.32 / $131.85	Professional	TC	$57.32	$57.32	$131.85
BCBS Facility/Professional Facility Modifier Low / Median / High Price $137.68 / $196.75 / $341.96	Facility		$137.68	$196.75	$341.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.84 / $148.49 / $196.01	Professional		$39.84	$148.49	$196.01
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.22 / $42.61 / $42.61	Professional	26	$36.22	$42.61	$42.61
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $112.27 / $132.08 / $132.08	Professional	TC	$112.27	$132.08	$132.08
CareSource Facility/Professional Facility Modifier Low / Median / High Price $26.53 / $88.42 / $137.84	Facility		$26.53	$88.42	$137.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $95.11 / $133.02	Professional		$28.58	$95.11	$133.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $123.40 / $123.40 / $123.40	Facility		$123.40	$123.40	$123.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.47 / $30.47 / $30.47	Facility	26	$30.47	$30.47	$30.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $88.02 / $135.79 / $298.95	Professional		$88.02	$135.79	$298.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.51 / $33.34 / $79.93	Professional	26	$21.51	$33.34	$79.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.18 / $100.39 / $241.54	Professional	TC	$62.18	$100.39	$241.54
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $99.77 / $306.70 / $657.07	Facility		$99.77	$306.70	$657.07
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $21.77 / $32.29 / $36.15	Facility	26	$21.77	$32.29	$36.15
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $96.60 / $126.46 / $262.83	Professional		$96.60	$126.46	$262.83
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $21.77 / $32.29 / $100.25	Professional	26	$21.77	$32.29	$100.25
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $49.22 / $63.23 / $177.57	Professional	52	$49.22	$63.23	$177.57
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $74.83 / $94.28 / $173.71	Professional	TC	$74.83	$94.28	$173.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.56 / $84.82 / $163.01	Professional		$36.56	$84.82	$163.01
United Facility/Professional Facility Modifier Low / Median / High Price $24.44 / $108.97 / $143.63	Facility		$24.44	$108.97	$143.63
United Facility/Professional Professional Modifier Low / Median / High Price $93.66 / $118.46 / $171.26	Professional		$93.66	$118.46	$171.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.52 / $30.03 / $41.59	Professional	26	$24.52	$30.03	$41.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.11 / $89.14 / $129.66	Professional	TC	$70.11	$89.14	$129.66