Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $128.82 / $281.84	Facility		$43.65	$128.82	$281.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $10.23 / $13.18	Facility	26	$10.23	$10.23	$13.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $60.26 / $234.42	Facility	TC	$30.20	$60.26	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $38.02 / $114.82	Professional		$9.12	$38.02	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.88 / $44.67	Professional	26	$7.94	$12.88	$44.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $37.15 / $138.04 / $194.98	Professional	50	$37.15	$138.04	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $30.20 / $69.18	Professional	TC	$19.95	$30.20	$69.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $32.36 / $50.12	Professional		$25.70	$32.36	$50.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $8.51 / $14.13	Professional	26	$6.92	$8.51	$14.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $25.12 / $34.67	Professional	TC	$21.88	$25.12	$34.67
BCBS Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $67.61 / $114.82	Facility		$44.67	$67.61	$114.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $102.33 / $107.15	Professional		$50.12	$102.33	$107.15
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $13.80 / $13.80	Professional	26	$13.80	$13.80	$13.80
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $114.82 / $114.82 / $114.82	Professional	50	$114.82	$114.82	$114.82
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $42.66 / $42.66	Professional	TC	$42.66	$42.66	$42.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.23 / $30.90 / $46.77	Facility		$10.23	$30.90	$46.77
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $30.90 / $50.12	Professional		$9.55	$30.90	$50.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $54.95 / $74.13	Facility		$54.95	$54.95	$74.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.31 / $29.51 / $41.69	Facility	TC	$6.31	$29.51	$41.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $43.65 / $95.50	Professional		$27.54	$43.65	$95.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $12.30 / $25.70	Professional	26	$7.41	$12.30	$25.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $35.48 / $77.62	Professional	TC	$20.42	$35.48	$77.62
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $131.83 / $288.40	Facility		$42.66	$131.83	$288.40
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $10.23 / $19.50	Facility	26	$10.23	$10.23	$19.50
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $56.23 / $234.42	Facility	TC	$30.20	$56.23	$234.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $40.74 / $102.33	Professional		$22.91	$40.74	$102.33
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.96 / $36.31	Professional	26	$7.41	$10.96	$36.31
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $32.36 / $89.13 / $323.59	Professional	50	$32.36	$89.13	$323.59
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $30.20 / $56.23	Professional	TC	$19.05	$30.20	$56.23
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $54.95 / $74.13	Facility		$54.95	$54.95	$74.13
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $6.31 / $29.51 / $41.69	Facility	TC	$6.31	$29.51	$41.69
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $33.88 / $75.86	Professional		$25.12	$33.88	$75.86
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.47 / $22.39	Professional	26	$7.08	$10.47	$22.39
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $26.30 / $74.13	Professional	TC	$18.20	$26.30	$74.13
United Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $70.79 / $229.09	Facility		$25.12	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $35.48 / $52.48	Professional		$29.51	$35.48	$52.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $10.23 / $15.49	Professional	26	$8.51	$10.23	$15.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $25.12 / $38.02	Professional	TC	$20.89	$25.12	$38.02