Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.64 / $141.44 / $157.94	Facility		$56.64	$141.44	$157.94
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.99 / $36.72 / $44.08	Facility	26	$34.99	$36.72	$44.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.13 / $78.00 / $150.00	Professional		$46.13	$78.00	$150.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.70 / $34.99 / $64.68	Professional	26	$27.70	$34.99	$64.68
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $124.53 / $163.68 / $209.18	Professional	50	$124.53	$163.68	$209.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.55 / $26.98 / $29.12	Professional	52	$19.55	$26.98	$29.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.26 / $37.26 / $97.78	Professional	TC	$16.26	$37.26	$97.78
BCBS Facility/Professional Facility Modifier Low / Median / High Price $41.93 / $79.29 / $158.77	Facility		$41.93	$79.29	$158.77
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.90 / $74.61 / $235.52	Professional		$25.90	$74.61	$235.52
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.40 / $47.40 / $47.40	Professional	26	$47.40	$47.40	$47.40
CareSource Facility/Professional Facility Modifier Low / Median / High Price $16.89 / $34.50 / $60.38	Facility		$16.89	$34.50	$60.38
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.97 / $36.09 / $58.29	Professional		$16.97	$36.09	$58.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.57 / $52.57 / $52.57	Facility		$52.57	$52.57	$52.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.59 / $85.17 / $163.31	Professional		$42.59	$85.17	$163.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.08 / $36.04 / $81.75	Professional	26	$26.08	$36.04	$81.75
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $77.25 / $77.25 / $77.25	Professional	50	$77.25	$77.25	$77.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.36 / $48.00 / $94.00	Professional	TC	$16.36	$48.00	$94.00
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $84.28 / $151.63 / $157.94	Facility		$84.28	$151.63	$157.94
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $29.04 / $29.04 / $44.08	Facility	26	$29.04	$29.04	$44.08
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $48.13 / $79.34 / $125.52	Professional		$48.13	$79.34	$125.52
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.34 / $34.99 / $69.50	Professional	26	$28.34	$34.99	$69.50
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $163.68 / $163.68 / $209.18	Professional	50	$163.68	$163.68	$209.18
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $21.87 / $26.98 / $79.62	Professional	52	$21.87	$26.98	$79.62
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.48 / $38.20 / $74.56	Professional	TC	$18.48	$38.20	$74.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $46.01 / $80.52	Professional		$28.58	$46.01	$80.52
United Facility/Professional Professional Modifier Low / Median / High Price $59.84 / $90.57 / $131.88	Professional		$59.84	$90.57	$131.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $34.36 / $47.51	Professional	26	$27.00	$34.36	$47.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.26 / $53.63 / $71.84	Professional	TC	$27.26	$53.63	$71.84