Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $165.96 / $407.38	Facility		$46.77	$165.96	$407.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $10.72 / $12.02	Facility	26	$10.72	$10.72	$12.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $89.13 / $275.42	Facility	TC	$28.84	$89.13	$275.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $41.69 / $107.15	Professional		$10.47	$41.69	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $14.13 / $51.29	Professional	26	$8.51	$14.13	$51.29
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.48 / $79.43 / $186.21	Professional	50	$35.48	$79.43	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $35.48 / $87.10	Professional	TC	$19.95	$35.48	$87.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $28.18 / $46.77	Professional		$22.39	$28.18	$46.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $8.91 / $15.14	Professional	26	$6.92	$8.91	$15.14
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $46.77 / $58.88	Professional	50	$39.81	$46.77	$58.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $28.18 / $40.74	Professional	TC	$18.62	$28.18	$40.74
BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $63.10 / $109.65	Facility		$40.74	$63.10	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $74.13 / $104.71	Professional		$51.29	$74.13	$104.71
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $14.45 / $19.50	Professional	26	$14.45	$14.45	$19.50
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	50	$109.65	$109.65	$109.65
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $40.74 / $54.95	Professional	TC	$40.74	$40.74	$54.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.47 / $30.20 / $45.71	Facility		$10.47	$30.20	$45.71
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $29.51 / $47.86	Professional		$10.00	$29.51	$47.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Facility		$53.70	$53.70	$53.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.03 / $28.18 / $39.81	Facility	TC	$6.03	$28.18	$39.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $45.71 / $93.33	Professional		$26.30	$45.71	$93.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $12.88 / $26.30	Professional	26	$7.76	$12.88	$26.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $32.36 / $74.13	Professional	TC	$18.62	$32.36	$74.13
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $177.83 / $407.38	Facility		$42.66	$177.83	$407.38
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $10.72 / $20.42	Facility	26	$10.72	$10.72	$20.42
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $93.33 / $275.42	Facility	TC	$28.84	$93.33	$275.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $42.66 / $104.71	Professional		$22.39	$42.66	$104.71
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $12.30 / $48.98	Professional	26	$8.32	$12.30	$48.98
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $33.88 / $87.10 / $199.53	Professional	50	$33.88	$87.10	$199.53
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $30.20 / $69.18	Professional	TC	$19.05	$30.20	$69.18
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Facility		$53.70	$53.70	$53.70
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $6.03 / $28.18 / $39.81	Facility	TC	$6.03	$28.18	$39.81
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $34.67 / $74.13	Professional		$23.44	$34.67	$74.13
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $9.77 / $23.44	Professional	26	$6.46	$9.77	$23.44
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $70.79	Professional	TC	$16.98	$25.12	$70.79
United Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $70.79 / $229.09	Facility		$23.44	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $51.29	Professional		$28.18	$33.11	$51.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $10.47 / $15.49	Professional	26	$8.51	$10.47	$15.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $22.39 / $36.31	Professional	TC	$19.05	$22.39	$36.31