Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $141.25 / $302.00	Facility		$38.02	$141.25	$302.00
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 $26.92 / $63.10 / $190.55	Facility	TC	$26.92	$63.10	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $36.31 / $112.20	Professional		$11.22	$36.31	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $15.49 / $50.12	Professional	26	$7.08	$15.49	$50.12
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $31.62 / $79.43 / $177.83	Professional	50	$31.62	$79.43	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $29.51 / $72.44	Professional	TC	$17.78	$29.51	$72.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $26.92 / $43.65	Professional		$21.88	$26.92	$43.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $7.59 / $12.88	Professional	26	$6.03	$7.59	$12.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $56.23 / $56.23 / $56.23	Professional	50	$56.23	$56.23	$56.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $22.91 / $34.67	Professional	TC	$19.05	$22.91	$34.67
BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $58.88 / $102.33	Facility		$39.81	$58.88	$102.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $67.61 / $95.50	Professional		$35.48	$67.61	$95.50
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 $102.33 / $102.33 / $138.04	Professional	50	$102.33	$102.33	$138.04
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $38.02 / $51.29	Professional	TC	$38.02	$38.02	$51.29
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.91 / $27.54 / $41.69	Facility		$8.91	$27.54	$41.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $27.54 / $44.67	Professional		$8.51	$27.54	$44.67
Cigna Facility/Professional Facility Modifier Low / Median / High Price $16.60 / $48.98 / $53.70	Facility		$16.60	$48.98	$53.70
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 $5.62 / $26.30 / $37.15	Facility	TC	$5.62	$26.30	$37.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $38.02 / $85.11	Professional		$23.99	$38.02	$85.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $10.96 / $22.39	Professional	26	$6.61	$10.96	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $31.62 / $69.18	Professional	TC	$17.38	$31.62	$69.18
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $147.91 / $316.23	Facility		$37.15	$147.91	$316.23
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $9.12 / $17.78	Facility	26	$9.12	$9.12	$17.78
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $26.92 / $48.98 / $194.98	Facility	TC	$26.92	$48.98	$194.98
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $37.15 / $102.33	Professional		$21.38	$37.15	$102.33
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.96 / $44.67	Professional	26	$7.08	$10.96	$44.67
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $31.62 / $95.50 / $257.04	Professional	50	$31.62	$95.50	$257.04
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $26.92 / $56.23	Professional	TC	$17.38	$26.92	$56.23
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $16.60 / $48.98 / $53.70	Facility		$16.60	$48.98	$53.70
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 $5.62 / $26.30 / $37.15	Facility	TC	$5.62	$26.30	$37.15
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $29.51 / $67.61	Professional		$21.88	$29.51	$67.61
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $9.55 / $19.95	Professional	26	$5.89	$9.55	$19.95
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $22.91 / $66.07	Professional	TC	$15.49	$22.91	$66.07
United Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $70.79 / $229.09	Facility		$21.38	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $30.20 / $46.77	Professional		$25.12	$30.20	$46.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $9.12 / $13.80	Professional	26	$7.59	$9.12	$13.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $21.38 / $33.88	Professional	TC	$17.78	$21.38	$33.88