Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $88.46 / $192.46 / $481.10	Facility		$88.46	$192.46	$481.10
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.65 / $38.65 / $48.71	Facility	26	$38.65	$38.65	$48.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.06 / $97.63 / $373.80	Professional		$78.06	$97.63	$373.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.15 / $38.65 / $137.60	Professional	26	$30.15	$38.65	$137.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $162.43 / $269.27 / $727.50	Professional	50	$162.43	$269.27	$727.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.98 / $58.97 / $98.54	Professional	TC	$46.98	$58.97	$98.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.07 / $70.18 / $82.57	Professional		$63.07	$70.18	$82.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.88 / $34.74 / $61.38	Professional	26	$25.88	$34.74	$61.38
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $90.40 / $95.28 / $98.47	Professional	50	$90.40	$95.28	$98.47
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.94 / $42.83 / $102.13	Professional	TC	$35.94	$42.83	$102.13
BCBS Facility/Professional Facility Modifier Low / Median / High Price $101.46 / $175.17 / $302.81	Facility		$101.46	$175.17	$302.81
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.71 / $120.17 / $281.38	Professional		$50.71	$120.17	$281.38
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.91 / $51.66 / $51.66	Professional	26	$43.91	$51.66	$51.66
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $229.98 / $270.56 / $270.56	Professional	50	$229.98	$270.56	$270.56
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.08 / $71.08 / $83.62	Professional	TC	$71.08	$71.08	$83.62
CareSource Facility/Professional Facility Modifier Low / Median / High Price $32.26 / $57.88 / $107.46	Facility		$32.26	$57.88	$107.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.59 / $60.19 / $101.87	Professional		$34.59	$60.19	$101.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $95.07 / $95.07 / $95.07	Facility		$95.07	$95.07	$95.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.03 / $37.03 / $37.03	Facility	26	$37.03	$37.03	$37.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.29 / $105.49 / $229.43	Professional		$68.29	$105.49	$229.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.36 / $40.98 / $95.11	Professional	26	$26.36	$40.98	$95.11
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $105.05 / $129.22 / $148.03	Professional	50	$105.05	$129.22	$148.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.94 / $65.23 / $151.49	Professional	TC	$41.94	$65.23	$151.49
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $96.15 / $229.50 / $512.23	Facility		$96.15	$229.50	$512.23
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $26.49 / $38.65 / $40.59	Facility	26	$26.49	$38.65	$40.59
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $67.34 / $97.62 / $239.35	Professional		$67.34	$97.62	$239.35
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $26.49 / $38.65 / $91.08	Professional	26	$26.49	$38.65	$91.08
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $162.43 / $269.27 / $727.50	Professional	50	$162.43	$269.27	$727.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $40.85 / $58.96 / $90.70	Professional	TC	$40.85	$58.96	$90.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.83 / $77.58 / $119.35	Professional		$35.83	$77.58	$119.35
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 $77.04 / $94.72 / $126.37	Professional		$77.04	$94.72	$126.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.00 / $38.28 / $50.99	Professional	26	$31.00	$38.28	$50.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.50 / $58.08 / $75.38	Professional	TC	$47.50	$58.08	$75.38