Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $144.54 / $302.00	Facility		$56.23	$144.54	$302.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $15.49	Facility	26	$12.30	$12.30	$15.49
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $47.86 / $204.17	Facility	TC	$25.70	$47.86	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $48.98 / $158.49	Professional		$28.18	$48.98	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.13 / $47.86	Professional	26	$9.55	$14.13	$47.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $27.54 / $64.57	Professional	TC	$18.20	$27.54	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $26.30 / $43.65	Professional		$21.38	$26.30	$43.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.55 / $16.22	Professional	26	$7.76	$9.55	$16.22
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $23.44 / $31.62	Professional	TC	$16.98	$23.44	$31.62
BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $57.54 / $100.00	Facility		$38.90	$57.54	$100.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $50.12 / $53.70	Professional		$39.81	$50.12	$53.70
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $16.60 / $16.60	Professional	26	$16.60	$16.60	$16.60
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $37.15 / $37.15	Professional	TC	$37.15	$37.15	$37.15
CareSource Facility/Professional Facility Modifier Low / Median / High Price $12.02 / $27.54 / $44.67	Facility		$12.02	$27.54	$44.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $26.92 / $46.77	Professional		$11.48	$26.92	$46.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $52.48 / $70.79	Facility		$52.48	$52.48	$70.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.51 / $11.75 / $16.98	Facility	26	$2.51	$11.75	$16.98
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.37 / $25.12 / $36.31	Facility	TC	$5.37	$25.12	$36.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $40.74 / $91.20	Professional		$26.30	$40.74	$91.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $14.45 / $30.20	Professional	26	$8.71	$14.45	$30.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $30.20 / $67.61	Professional	TC	$17.78	$30.20	$67.61
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $141.25 / $309.03	Facility		$47.86	$141.25	$309.03
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $22.91	Facility	26	$12.30	$12.30	$22.91
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $61.66 / $229.09	Facility	TC	$25.70	$61.66	$229.09
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $41.69 / $123.03	Professional		$27.54	$41.69	$123.03
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.49 / $45.71	Professional	26	$9.55	$13.49	$45.71
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $25.70 / $54.95	Professional	TC	$17.78	$25.70	$54.95
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $52.48 / $70.79	Facility		$52.48	$52.48	$70.79
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.51 / $11.75 / $16.98	Facility	26	$2.51	$11.75	$16.98
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $5.37 / $25.12 / $36.31	Facility	TC	$5.37	$25.12	$36.31
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $32.36 / $72.44	Professional		$24.55	$32.36	$72.44
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $12.02 / $26.92	Professional	26	$8.13	$12.02	$26.92
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $22.91 / $64.57	Professional	TC	$15.85	$22.91	$64.57
United Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $70.79 / $229.09	Facility		$21.38	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $50.12	Professional		$28.18	$33.11	$50.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $12.02 / $17.78	Professional	26	$10.00	$12.02	$17.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $21.38 / $33.11	Professional	TC	$17.78	$21.38	$33.11