Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $144.54 / $309.03	Facility		$38.90	$144.54	$309.03
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 $26.92 / $64.57 / $173.78	Facility	TC	$26.92	$64.57	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $38.02 / $114.82	Professional		$11.48	$38.02	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $15.49 / $43.65	Professional	26	$7.76	$15.49	$43.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.67 / $114.82 / $186.21	Professional	50	$34.67	$114.82	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $35.48 / $83.18	Professional	TC	$19.95	$35.48	$83.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $26.92 / $43.65	Professional		$21.88	$26.92	$43.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $8.32 / $14.13	Professional	26	$6.61	$8.32	$14.13
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $58.88 / $58.88 / $58.88	Professional	50	$58.88	$58.88	$58.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $26.92 / $34.67	Professional	TC	$18.62	$26.92	$34.67
BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $60.26 / $102.33	Facility		$40.74	$60.26	$102.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $64.57 / $97.72	Professional		$36.31	$64.57	$97.72
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 50 Low / Median / High Price $104.71 / $104.71 / $141.25	Professional	50	$104.71	$104.71	$141.25
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $38.90 / $52.48	Professional	TC	$38.90	$38.90	$52.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $28.18 / $42.66	Facility		$9.77	$28.18	$42.66
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $28.18 / $45.71	Professional		$9.33	$28.18	$45.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $56.23 / $69.18	Facility		$51.29	$56.23	$69.18
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 $5.62 / $26.30 / $38.02	Facility	TC	$5.62	$26.30	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $42.66 / $89.13	Professional		$26.92	$42.66	$89.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $11.75 / $24.55	Professional	26	$6.92	$11.75	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $32.36 / $69.18	Professional	TC	$19.95	$32.36	$69.18
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $147.91 / $331.13	Facility		$38.02	$147.91	$331.13
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $17.78	Facility	26	$10.00	$10.00	$17.78
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $26.92 / $64.57 / $194.98	Facility	TC	$26.92	$64.57	$194.98
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $39.81 / $97.72	Professional		$19.95	$39.81	$97.72
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $11.22 / $36.31	Professional	26	$7.41	$11.22	$36.31
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $34.67 / $93.33 / $323.59	Professional	50	$34.67	$93.33	$323.59
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $29.51 / $61.66	Professional	TC	$20.42	$29.51	$61.66
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $56.23 / $69.18	Facility		$51.29	$56.23	$69.18
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 $5.62 / $26.30 / $38.02	Facility	TC	$5.62	$26.30	$38.02
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $33.11 / $75.86	Professional		$25.12	$33.11	$75.86
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 $18.62 / $25.70 / $66.07	Professional	TC	$18.62	$25.70	$66.07
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 $28.84 / $34.67 / $50.12	Professional		$28.84	$34.67	$50.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.33 / $14.45	Professional	26	$7.94	$9.33	$14.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $25.70 / $36.31	Professional	TC	$20.42	$25.70	$36.31