Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $123.03 / $275.42	Facility		$37.15	$123.03	$275.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $10.23 / $13.18	Facility	26	$10.23	$10.23	$13.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.50 / $26.92 / $190.55	Facility	TC	$19.50	$26.92	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $29.51 / $95.50	Professional		$17.78	$29.51	$95.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.47 / $38.90	Professional	26	$7.94	$10.47	$38.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $18.62 / $37.15	Professional	TC	$10.00	$18.62	$37.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $19.05 / $25.70	Professional		$16.22	$19.05	$25.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $7.76 / $13.80	Professional	26	$6.46	$7.76	$13.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $13.18 / $14.79 / $16.98	Professional	TC	$13.18	$14.79	$16.98
BCBS Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $42.66 / $74.13	Facility		$27.54	$42.66	$74.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $38.90 / $41.69	Professional		$24.55	$38.90	$41.69
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $13.80 / $13.80	Professional	26	$13.80	$13.80	$13.80
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $27.54 / $27.54	Professional	TC	$27.54	$27.54	$27.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.23 / $20.42 / $33.88	Facility		$10.23	$20.42	$33.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $19.95 / $35.48	Professional		$9.55	$19.95	$35.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $40.74 / $53.70	Facility		$40.74	$40.74	$53.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $4.07 / $19.05 / $26.92	Facility	TC	$4.07	$19.05	$26.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $30.20 / $69.18	Professional		$19.50	$30.20	$69.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $12.30 / $25.70	Professional	26	$7.41	$12.30	$25.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $18.62 / $50.12	Professional	TC	$10.47	$18.62	$50.12
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $123.03 / $281.84	Facility		$30.90	$123.03	$281.84
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $10.23 / $17.78	Facility	26	$10.23	$10.23	$17.78
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $19.50 / $34.67 / $204.17	Facility	TC	$19.50	$34.67	$204.17
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $28.84 / $72.44	Professional		$17.38	$28.84	$72.44
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.96 / $37.15	Professional	26	$7.94	$10.96	$37.15
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $9.55 / $19.05 / $34.67	Professional	TC	$9.55	$19.05	$34.67
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $40.74 / $53.70	Facility		$40.74	$40.74	$53.70
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $4.07 / $19.05 / $26.92	Facility	TC	$4.07	$19.05	$26.92
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $23.44 / $56.23	Professional		$17.78	$23.44	$56.23
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.00 / $22.39	Professional	26	$6.76	$10.00	$22.39
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $15.85 / $46.77	Professional	TC	$9.77	$15.85	$46.77
United Facility/Professional Facility Modifier Low / Median / High Price $11.75 / $70.79 / $229.09	Facility		$11.75	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $24.55 / $37.15	Professional		$19.05	$24.55	$37.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.00 / $15.14	Professional	26	$8.32	$10.00	$15.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $14.79 / $22.91	Professional	TC	$10.47	$14.79	$22.91