Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $138.04 / $389.05	Facility		$48.98	$138.04	$389.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $10.72 / $14.13	Facility	26	$10.72	$10.72	$14.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $35.48 / $83.18 / $204.17	Facility	TC	$35.48	$83.18	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $50.12 / $147.91	Professional		$11.75	$50.12	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $18.62 / $54.95	Professional	26	$8.51	$18.62	$54.95
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $21.88 / $93.33 / $223.87	Professional	50	$21.88	$93.33	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $41.69 / $102.33	Professional	TC	$25.12	$41.69	$102.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $33.11 / $54.95	Professional		$26.92	$33.11	$54.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $10.00 / $16.98	Professional	26	$7.24	$10.00	$16.98
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $40.74 / $47.86 / $91.20	Professional	50	$40.74	$47.86	$91.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $32.36 / $50.12	Professional	TC	$23.99	$32.36	$50.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $79.43 / $134.90	Facility		$52.48	$79.43	$134.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $114.82 / $120.23	Professional		$60.26	$114.82	$120.23
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 $128.82 / $128.82 / $128.82	Professional	50	$128.82	$128.82	$128.82
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $67.61	Professional	TC	$50.12	$50.12	$67.61
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.47 / $36.31 / $52.48	Facility		$10.47	$36.31	$52.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $35.48 / $56.23	Professional		$10.00	$35.48	$56.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $60.26 / $85.11	Facility		$58.88	$60.26	$85.11
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 $7.41 / $34.67 / $48.98	Facility	TC	$7.41	$34.67	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $48.98 / $109.65	Professional		$30.90	$48.98	$109.65
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 $23.99 / $38.90 / $91.20	Professional	TC	$23.99	$38.90	$91.20
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $147.91 / $407.38	Facility		$47.86	$147.91	$407.38
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $10.72 / $23.99	Facility	26	$10.72	$10.72	$23.99
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $35.48 / $83.18 / $218.78	Facility	TC	$35.48	$83.18	$218.78
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $50.12 / $128.82	Professional		$26.30	$50.12	$128.82
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $13.18 / $52.48	Professional	26	$8.51	$13.18	$52.48
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $36.31 / $102.33 / $263.03	Professional	50	$36.31	$102.33	$263.03
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $36.31 / $83.18	Professional	TC	$24.55	$36.31	$83.18
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $60.26 / $85.11	Facility		$58.88	$60.26	$85.11
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 $7.41 / $34.67 / $48.98	Facility	TC	$7.41	$34.67	$48.98
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $37.15 / $87.10	Professional		$28.84	$37.15	$87.10
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.47 / $23.44	Professional	26	$6.46	$10.47	$23.44
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $29.51 / $87.10	Professional	TC	$21.38	$29.51	$87.10
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 $32.36 / $38.90 / $58.88	Professional		$32.36	$38.90	$58.88
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 $23.99 / $28.18 / $44.67	Professional	TC	$23.99	$28.18	$44.67