Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.83 / $219.88 / $303.26	Facility		$44.83	$219.88	$303.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.48 / $25.70 / $30.84	Facility	26	$24.48	$25.70	$30.84
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.13 / $220.57 / $294.72	Facility	TC	$19.13	$220.57	$294.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.20 / $71.59 / $130.00	Professional		$38.20	$71.59	$130.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.00 / $24.48 / $60.78	Professional	26	$18.00	$24.48	$60.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $85.42 / $234.74 / $281.35	Professional	50	$85.42	$234.74	$281.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.48 / $21.35 / $37.61	Professional	52	$15.48	$21.35	$37.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.14 / $39.53 / $80.70	Professional	TC	$17.14	$39.53	$80.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.78 / $35.78 / $35.78	Professional		$35.78	$35.78	$35.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.88 / $26.88 / $26.88	Professional	26	$26.88	$26.88	$26.88
BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.17 / $78.70 / $154.94	Facility		$38.17	$78.70	$154.94
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.62 / $54.78 / $172.81	Professional		$25.62	$54.78	$172.81
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.62 / $32.49 / $32.49	Professional	26	$27.62	$32.49	$32.49
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.19 / $26.10 / $26.10	Professional	TC	$22.19	$26.10	$26.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $15.19 / $23.00 / $45.95	Facility		$15.19	$23.00	$45.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.00 / $24.92 / $45.95	Professional		$16.00	$24.92	$45.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $41.38 / $41.38	Facility		$41.38	$41.38	$41.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	26	$23.35	$23.35	$23.35
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Facility	TC	$18.64	$18.64	$18.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.19 / $74.61 / $129.38	Professional		$33.19	$74.61	$129.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.20 / $26.11 / $49.65	Professional	26	$15.20	$26.11	$49.65
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $76.11 / $76.11 / $76.11	Professional	50	$76.11	$76.11	$76.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.75 / $37.47 / $84.46	Professional	TC	$14.75	$37.47	$84.46
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $74.14 / $241.08 / $303.26	Facility		$74.14	$241.08	$303.26
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $22.49 / $22.49 / $30.84	Facility	26	$22.49	$22.49	$30.84
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $22.95 / $216.09 / $294.72	Facility	TC	$22.95	$216.09	$294.72
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $40.09 / $71.59 / $115.00	Professional		$40.09	$71.59	$115.00
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $21.42 / $24.48 / $59.12	Professional	26	$21.42	$24.48	$59.12
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $234.74	Professional	50	$234.74	$234.74	$234.74
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $17.27 / $21.35 / $44.27	Professional	52	$17.27	$21.35	$44.27
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $46.69 / $69.12	Professional	TC	$18.21	$46.69	$69.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $32.91 / $46.52	Professional		$26.31	$32.91	$46.52
United Facility/Professional Professional Modifier Low / Median / High Price $43.54 / $70.50 / $110.62	Professional		$43.54	$70.50	$110.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.80 / $25.15 / $35.71	Professional	26	$19.80	$25.15	$35.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.05 / $46.68 / $63.00	Professional	TC	$21.05	$46.68	$63.00