Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $138.04 / $295.12	Facility		$34.67	$138.04	$295.12
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $9.12 / $11.48	Facility	26	$9.12	$9.12	$11.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $47.86 / $165.96	Facility	TC	$23.99	$47.86	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $33.88 / $93.33	Professional		$11.75	$33.88	$93.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $15.14 / $45.71	Professional	26	$7.08	$15.14	$45.71
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.78 / $104.71 / $251.19	Professional	50	$17.78	$104.71	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $26.30 / $56.23	Professional	TC	$16.98	$26.30	$56.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $23.99 / $37.15	Professional		$18.20	$23.99	$37.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $7.59 / $12.88	Professional	26	$5.89	$7.59	$12.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $20.42 / $28.84	Professional	TC	$18.20	$20.42	$28.84
BCBS Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $53.70 / $91.20	Facility		$36.31	$53.70	$91.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $46.77 / $87.10	Professional		$41.69	$46.77	$87.10
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $12.30 / $16.60	Professional	26	$12.30	$12.30	$16.60
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $93.33 / $93.33 / $117.49	Professional	50	$93.33	$93.33	$117.49
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $34.67 / $46.77	Professional	TC	$34.67	$34.67	$46.77
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.91 / $25.70 / $38.02	Facility		$8.91	$25.70	$38.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $25.12 / $40.74	Professional		$8.51	$25.12	$40.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $45.71 / $45.71	Facility		$45.71	$45.71	$45.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.88	Facility	TC	$5.01	$23.44	$33.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $38.02 / $79.43	Professional		$22.91	$38.02	$79.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.96 / $22.39	Professional	26	$6.46	$10.96	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $28.84 / $63.10	Professional	TC	$16.98	$28.84	$63.10
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $144.54 / $288.40	Facility		$33.88	$144.54	$288.40
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $9.12 / $16.60	Facility	26	$9.12	$9.12	$16.60
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $44.67 / $165.96	Facility	TC	$23.99	$44.67	$165.96
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $34.67 / $87.10	Professional		$20.42	$34.67	$87.10
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.96 / $38.90	Professional	26	$7.08	$10.96	$38.90
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $17.78 / $104.71 / $281.84	Professional	50	$17.78	$104.71	$281.84
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $25.12 / $45.71	Professional	TC	$17.38	$25.12	$45.71
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $45.71 / $45.71	Facility		$45.71	$45.71	$45.71
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.88	Facility	TC	$5.01	$23.44	$33.88
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $29.51 / $63.10	Professional		$19.95	$29.51	$63.10
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $8.71 / $19.95	Professional	26	$5.62	$8.71	$19.95
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $21.88 / $58.88	Professional	TC	$14.79	$21.88	$58.88
United Facility/Professional Facility Modifier Low / Median / High Price $20.89 / $70.79 / $229.09	Facility		$20.89	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $29.51 / $44.67	Professional		$25.12	$29.51	$44.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $8.71 / $13.80	Professional	26	$7.41	$8.71	$13.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $20.42 / $30.90	Professional	TC	$16.98	$20.42	$30.90