Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $144.54 / $302.00	Facility		$33.11	$144.54	$302.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $12.59	Facility	26	$10.00	$10.00	$12.59
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.88 / $27.54 / $67.61	Facility	TC	$21.88	$27.54	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $37.15 / $107.15	Professional		$22.91	$37.15	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $11.48 / $37.15	Professional	26	$7.76	$11.48	$37.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $22.39 / $52.48	Professional	TC	$15.14	$22.39	$52.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $23.44 / $42.66	Professional		$17.78	$23.44	$42.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.32 / $14.13	Professional	26	$6.46	$8.32	$14.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $21.38 / $32.36	Professional	TC	$15.85	$21.38	$32.36
BCBS Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $47.86 / $83.18	Facility		$33.11	$47.86	$83.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $41.69 / $44.67	Professional		$23.44	$41.69	$44.67
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $13.18 / $17.78	Professional	26	$13.18	$13.18	$17.78
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $31.62 / $42.66	Professional	TC	$31.62	$31.62	$42.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $23.44 / $36.31	Facility		$9.77	$23.44	$36.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $22.39 / $38.90	Professional		$9.33	$22.39	$38.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $43.65 / $43.65	Facility		$43.65	$43.65	$43.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $4.57 / $21.38 / $30.20	Facility	TC	$4.57	$21.38	$30.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $36.31 / $74.13	Professional		$23.99	$36.31	$74.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.75 / $24.55	Professional	26	$7.08	$11.75	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $26.30 / $56.23	Professional	TC	$16.60	$26.30	$56.23
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $138.04 / $316.23	Facility		$33.11	$138.04	$316.23
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $20.42	Facility	26	$10.00	$10.00	$20.42
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $21.88 / $30.90 / $234.42	Facility	TC	$21.88	$30.90	$234.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $33.88 / $79.43	Professional		$23.99	$33.88	$79.43
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $10.96 / $30.90	Professional	26	$7.76	$10.96	$30.90
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $22.39 / $45.71	Professional	TC	$15.85	$22.39	$45.71
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $43.65 / $43.65	Facility		$43.65	$43.65	$43.65
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $4.57 / $21.38 / $30.20	Facility	TC	$4.57	$21.38	$30.20
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $30.90 / $64.57	Professional		$22.39	$30.90	$64.57
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $9.55 / $21.38	Professional	26	$6.03	$9.55	$21.38
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $22.39 / $53.70	Professional	TC	$15.49	$22.39	$53.70
United Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $85.11 / $275.42	Facility		$21.38	$85.11	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $28.84 / $48.98	Professional		$25.12	$28.84	$48.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.77 / $14.45	Professional	26	$7.94	$9.77	$14.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $19.95 / $32.36	Professional	TC	$16.98	$19.95	$32.36