Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $154.88 / $331.13	Facility		$45.71	$154.88	$331.13
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $12.59 / $15.85	Facility	26	$12.59	$12.59	$15.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $40.74 / $181.97	Facility	TC	$32.36	$40.74	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $53.70 / $158.49	Professional		$33.11	$53.70	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $18.62 / $45.71	Professional	26	$10.00	$18.62	$45.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $35.48 / $79.43	Professional	TC	$22.91	$35.48	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $33.11 / $58.88	Professional		$26.30	$33.11	$58.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.23 / $17.38	Professional	26	$7.94	$10.23	$17.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $32.36 / $40.74	Professional	TC	$20.42	$32.36	$40.74
BCBS Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $70.79 / $123.03	Facility		$47.86	$70.79	$123.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $58.88 / $63.10	Professional		$43.65	$58.88	$63.10
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 $46.77 / $46.77 / $63.10	Professional	TC	$46.77	$46.77	$63.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $12.59 / $34.67 / $52.48	Facility		$12.59	$34.67	$52.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $34.67 / $54.95	Professional		$11.75	$34.67	$54.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
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 Facility Modifier TC Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	TC	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $52.48 / $107.15	Professional		$30.90	$52.48	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $15.14 / $30.90	Professional	26	$9.12	$15.14	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $38.02 / $83.18	Professional	TC	$21.38	$38.02	$83.18
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $154.88 / $354.81	Facility		$44.67	$154.88	$354.81
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $12.59 / $25.12	Facility	26	$12.59	$12.59	$25.12
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $60.26 / $194.98	Facility	TC	$32.36	$60.26	$194.98
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $50.12 / $114.82	Professional		$33.88	$50.12	$114.82
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.45 / $38.90	Professional	26	$10.00	$14.45	$38.90
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.11 / $61.66	Professional	TC	$23.44	$33.11	$61.66
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
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 Facility Modifier TC Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	TC	$6.76	$31.62	$44.67
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $38.90 / $85.11	Professional		$26.92	$38.90	$85.11
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 $19.50 / $28.18 / $79.43	Professional	TC	$19.50	$28.18	$79.43
United Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $70.79 / $229.09	Facility		$25.12	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $38.90 / $58.88	Professional		$33.11	$38.90	$58.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $12.30 / $18.62	Professional	26	$10.23	$12.30	$18.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $26.92 / $40.74	Professional	TC	$22.39	$26.92	$40.74