Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.88 / $61.24 / $168.48	Facility		$25.88	$61.24	$168.48
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.58 / $3.58 / $4.51	Facility	26	$3.58	$3.58	$4.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.72 / $29.01 / $61.75	Professional		$21.72	$29.01	$61.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.84 / $3.91 / $10.64	Professional	26	$2.84	$3.91	$10.64
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $8.40 / $12.94 / $13.32	Professional	52	$8.40	$12.94	$13.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.69 / $25.10 / $37.97	Professional	TC	$17.69	$25.10	$37.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.13 / $19.13 / $22.51	Professional		$19.13	$19.13	$22.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $3.13 / $3.13 / $4.23	Professional	26	$3.13	$3.13	$4.23
BCBS Facility/Professional Facility Modifier Low / Median / High Price $45.18 / $89.84 / $175.54	Facility		$45.18	$89.84	$175.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $6.72 / $36.08 / $47.29	Professional		$6.72	$36.08	$47.29
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $4.79 / $4.79 / $4.79	Professional	26	$4.79	$4.79	$4.79
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2.88 / $20.36 / $28.10	Facility		$2.88	$20.36	$28.10
CareSource Facility/Professional Professional Modifier Low / Median / High Price $3.07 / $20.42 / $29.19	Professional		$3.07	$20.42	$29.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.10 / $26.10 / $26.10	Facility		$26.10	$26.10	$26.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.41 / $3.41 / $3.41	Facility	26	$3.41	$3.41	$3.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $15.70 / $34.09 / $62.90	Professional		$15.70	$34.09	$62.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.20 / $4.90 / $12.19	Professional	26	$2.20	$4.90	$12.19
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $55.76 / $55.76 / $55.76	Professional	50	$55.76	$55.76	$55.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.50 / $28.92 / $48.53	Professional	TC	$13.50	$28.92	$48.53
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $25.87 / $125.71 / $168.48	Facility		$25.87	$125.71	$168.48
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $3.58 / $3.85 / $4.51	Facility	26	$3.58	$3.85	$4.51
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $24.07 / $27.20 / $54.13	Professional		$24.07	$27.20	$54.13
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $3.06 / $3.85 / $7.76	Professional	26	$3.06	$3.85	$7.76
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $9.31 / $12.94 / $35.00	Professional	52	$9.31	$12.94	$35.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.22 / $22.64 / $34.51	Professional	TC	$20.22	$22.64	$34.51
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 $21.80 / $29.13 / $55.70	Professional		$21.80	$29.13	$55.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.20 / $4.19 / $13.59	Professional	26	$3.20	$4.19	$13.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.17 / $23.71 / $38.71	Professional	TC	$18.17	$23.71	$38.71