Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $162.18 / $354.81	Facility		$46.77	$162.18	$354.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $12.59 / $15.85	Facility	26	$12.59	$12.59	$15.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.88 / $47.86 / $141.25	Facility	TC	$33.88	$47.86	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $48.98 / $154.88	Professional		$33.88	$48.98	$154.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.79 / $42.66	Professional	26	$8.91	$14.79	$42.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $120.23 / $204.17	Professional	50	$38.02	$120.23	$204.17
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $38.02 / $147.91 / $162.18	Professional	52	$38.02	$147.91	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $79.43	Professional	TC	$23.99	$33.88	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $33.11 / $58.88	Professional		$26.92	$33.11	$58.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $10.47 / $18.20	Professional	26	$8.51	$10.47	$18.20
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $14.13 / $14.13 / $14.13	Professional	52	$14.13	$14.13	$14.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $28.84 / $40.74	Professional	TC	$23.44	$28.84	$40.74
BCBS Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $75.86 / $128.82	Facility		$51.29	$75.86	$128.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $61.66 / $66.07	Professional		$45.71	$61.66	$66.07
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $16.98 / $16.98	Professional	26	$16.98	$16.98	$16.98
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $48.98 / $48.98	Professional	TC	$41.69	$48.98	$48.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $12.59 / $36.31 / $53.70	Facility		$12.59	$36.31	$53.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $35.48 / $57.54	Professional		$11.75	$35.48	$57.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $64.57 / $87.10	Facility		$64.57	$64.57	$87.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $7.08 / $33.11 / $47.86	Facility	TC	$7.08	$33.11	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $51.29 / $112.20	Professional		$32.36	$51.29	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $15.14 / $30.90	Professional	26	$9.12	$15.14	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $40.74 / $87.10	Professional	TC	$23.99	$40.74	$87.10
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $162.18 / $426.58	Facility		$46.77	$162.18	$426.58
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $12.59 / $23.99	Facility	26	$12.02	$12.59	$23.99
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $33.88 / $54.95 / $107.15	Facility	TC	$33.88	$54.95	$107.15
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $47.86 / $114.82	Professional		$33.11	$47.86	$114.82
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.88 / $33.11	Professional	26	$8.91	$12.88	$33.11
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $186.21 / $269.15	Professional	50	$38.02	$186.21	$269.15
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $38.02 / $147.91 / $162.18	Professional	52	$38.02	$147.91	$162.18
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $33.88 / $64.57	Professional	TC	$21.88	$33.88	$64.57
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $64.57 / $87.10	Facility		$64.57	$64.57	$87.10
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $7.08 / $33.11 / $47.86	Facility	TC	$7.08	$33.11	$47.86
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $41.69 / $89.13	Professional		$30.90	$41.69	$89.13
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $12.59 / $28.18	Professional	26	$8.71	$12.59	$28.18
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $30.20 / $83.18	Professional	TC	$22.39	$30.20	$83.18
United Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $85.11 / $275.42	Facility		$30.90	$85.11	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $41.69 / $61.66	Professional		$34.67	$41.69	$61.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $12.59 / $19.05	Professional	26	$10.47	$12.59	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $29.51 / $44.67	Professional	TC	$24.55	$29.51	$44.67