Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $128.82 / $257.04	Facility		$41.69	$128.82	$257.04
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $12.59 / $15.85	Facility	26	$12.02	$12.59	$15.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $39.81 / $117.49	Professional		$19.95	$39.81	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $17.38 / $53.70	Professional	26	$8.91	$17.38	$53.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $29.51 / $67.61	Professional	TC	$19.50	$29.51	$67.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $31.62 / $46.77	Professional		$24.55	$31.62	$46.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $13.80 / $20.89	Professional	26	$8.71	$13.80	$20.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $28.18 / $36.31	Professional	TC	$16.98	$28.18	$36.31
BCBS Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $63.10 / $109.65	Facility		$43.65	$63.10	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $54.95 / $58.88	Professional		$50.12	$54.95	$58.88
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $16.98 / $22.91	Professional	26	$16.98	$16.98	$22.91
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $41.69 / $52.48	Professional	TC	$35.48	$41.69	$52.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $12.59 / $30.90 / $47.86	Facility		$12.59	$30.90	$47.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $30.90 / $51.29	Professional		$11.75	$30.90	$51.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $57.54 / $75.86	Facility		$21.38	$57.54	$75.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $45.71 / $100.00	Professional		$28.18	$45.71	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.14 / $30.90	Professional	26	$8.91	$15.14	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $34.67 / $75.86	Professional	TC	$19.05	$34.67	$75.86
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $131.83 / $257.04	Facility		$41.69	$131.83	$257.04
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $12.59 / $23.44	Facility	26	$12.02	$12.59	$23.44
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $41.69 / $97.72	Professional		$26.30	$41.69	$97.72
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $13.49 / $38.02	Professional	26	$8.91	$13.49	$38.02
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $29.51 / $53.70	Professional	TC	$19.50	$29.51	$53.70
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $57.54 / $75.86	Facility		$21.38	$57.54	$75.86
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $34.67 / $79.43	Professional		$25.70	$34.67	$79.43
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $11.75 / $28.18	Professional	26	$7.59	$11.75	$28.18
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $25.12 / $70.79	Professional	TC	$17.38	$25.12	$70.79
United Facility/Professional Facility Modifier Low / Median / High Price $23.99 / $70.79 / $229.09	Facility		$23.99	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $35.48 / $54.95	Professional		$30.20	$35.48	$54.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $11.75 / $18.62	Professional	26	$10.00	$11.75	$18.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $23.99 / $37.15	Professional	TC	$19.95	$23.99	$37.15