Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $144.54 / $269.15	Facility		$38.90	$144.54	$269.15
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $11.48 / $12.30	Facility	26	$11.48	$11.48	$12.30
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $38.90 / $239.88	Facility	TC	$25.70	$38.90	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $45.71 / $138.04	Professional		$28.18	$45.71	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.49 / $40.74	Professional	26	$8.91	$15.49	$40.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $27.54 / $60.26	Professional	TC	$18.62	$27.54	$60.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $27.54 / $48.98	Professional		$21.38	$27.54	$48.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $9.55 / $20.42	Professional	26	$7.41	$9.55	$20.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $22.91 / $38.90	Professional	TC	$16.98	$22.91	$38.90
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 $38.90 / $48.98 / $52.48	Professional		$38.90	$48.98	$52.48
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $15.49 / $20.89	Professional	26	$15.49	$15.49	$20.89
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $37.15 / $50.12	Professional	TC	$37.15	$37.15	$50.12
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.22 / $27.54 / $43.65	Facility		$11.22	$27.54	$43.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $26.92 / $46.77	Professional		$10.72	$26.92	$46.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $51.29 / $51.29	Facility		$51.29	$51.29	$51.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.34 / $10.96 / $15.85	Facility	26	$2.34	$10.96	$15.85
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 $27.54 / $44.67 / $89.13	Professional		$27.54	$44.67	$89.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $13.80 / $28.18	Professional	26	$8.32	$13.80	$28.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $30.90 / $67.61	Professional	TC	$19.05	$30.90	$67.61
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $144.54 / $263.03	Facility		$38.90	$144.54	$263.03
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $11.48 / $23.44	Facility	26	$11.48	$11.48	$23.44
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $52.48 / $239.88	Facility	TC	$25.70	$52.48	$239.88
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $41.69 / $95.50	Professional		$28.18	$41.69	$95.50
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.88 / $35.48	Professional	26	$8.91	$12.88	$35.48
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $26.92 / $52.48	Professional	TC	$19.05	$26.92	$52.48
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $51.29 / $51.29	Facility		$51.29	$51.29	$51.29
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.34 / $10.96 / $15.85	Facility	26	$2.34	$10.96	$15.85
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 $26.30 / $34.67 / $74.13	Professional		$26.30	$34.67	$74.13
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $11.75 / $25.12	Professional	26	$7.24	$11.75	$25.12
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $24.55 / $64.57	Professional	TC	$16.98	$24.55	$64.57
United Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $85.11 / $275.42	Facility		$25.12	$85.11	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $35.48 / $53.70	Professional		$29.51	$35.48	$53.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $11.48 / $18.62	Professional	26	$9.55	$11.48	$18.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $23.44 / $34.67	Professional	TC	$19.05	$23.44	$34.67