Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $13.18 / $16.60	Facility	26	$13.18	$13.18	$16.60
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $39.81 / $93.33 / $239.88	Facility	TC	$39.81	$93.33	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $56.23 / $173.78	Professional		$21.88	$56.23	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $22.91 / $69.18	Professional	26	$10.00	$22.91	$69.18
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $44.67 / $114.82 / $269.15	Professional	50	$44.67	$114.82	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $47.86 / $120.23	Professional	TC	$28.18	$47.86	$120.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $38.90 / $69.18	Professional		$31.62	$38.90	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $12.30 / $22.39	Professional	26	$8.51	$12.30	$22.39
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $54.95 / $69.18 / $104.71	Professional	50	$54.95	$69.18	$104.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $40.74 / $63.10	Professional	TC	$25.70	$40.74	$63.10
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $102.33 / $141.25	Professional		$70.79	$102.33	$141.25
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $17.38 / $23.99	Professional	26	$17.38	$17.38	$23.99
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $151.36 / $151.36 / $204.17	Professional	50	$151.36	$151.36	$204.17
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $57.54 / $77.62	Professional	TC	$57.54	$57.54	$77.62
CareSource Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $40.74 / $66.07	Professional		$12.30	$40.74	$66.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $17.78	Facility	26	$2.69	$12.59	$17.78
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	TC	$8.51	$39.81	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $60.26 / $128.82	Professional		$36.31	$60.26	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $15.49 / $31.62	Professional	26	$9.33	$15.49	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $43.65 / $102.33	Professional	TC	$26.30	$43.65	$102.33
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $13.18 / $25.70	Facility	26	$13.18	$13.18	$25.70
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $39.81 / $93.33 / $263.03	Facility	TC	$39.81	$93.33	$263.03
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $56.23 / $144.54	Professional		$33.11	$56.23	$144.54
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.49 / $63.10	Professional	26	$10.00	$15.49	$63.10
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $45.71 / $123.03 / $363.08	Professional	50	$45.71	$123.03	$363.08
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $41.69 / $91.20	Professional	TC	$28.18	$41.69	$91.20
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $17.78	Facility	26	$2.69	$12.59	$17.78
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	TC	$8.51	$39.81	$56.23
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $43.65 / $102.33	Professional		$31.62	$43.65	$102.33
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $12.88 / $28.84	Professional	26	$7.76	$12.88	$28.84
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $100.00	Professional	TC	$23.99	$33.88	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $44.67 / $67.61	Professional		$38.02	$44.67	$67.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $12.59 / $18.62	Professional	26	$10.23	$12.59	$18.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $32.36 / $48.98	Professional	TC	$26.30	$32.36	$48.98