Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $128.82 / $275.42	Facility		$37.15	$128.82	$275.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $9.55 / $10.00	Facility	26	$9.55	$9.55	$10.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $41.69 / $162.18	Facility	TC	$27.54	$41.69	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $37.15 / $102.33	Professional		$15.85	$37.15	$102.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.18 / $40.74	Professional	26	$7.08	$13.18	$40.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.67 / $79.43 / $295.12	Professional	50	$34.67	$79.43	$295.12
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.49 / $28.18 / $107.15	Professional	52	$13.49	$28.18	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $28.18 / $66.07	Professional	TC	$18.62	$28.18	$66.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $26.30 / $45.71	Professional		$21.38	$26.30	$45.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $7.24 / $13.49	Professional	26	$5.75	$7.24	$13.49
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $42.66 / $42.66	Professional	50	$42.66	$42.66	$42.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $22.91 / $28.18	Professional	TC	$18.20	$22.91	$28.18
BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $60.26 / $102.33	Facility		$40.74	$60.26	$102.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $95.50 / $95.50	Professional		$47.86	$95.50	$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 $38.90 / $38.90 / $52.48	Professional	TC	$38.90	$38.90	$52.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.91 / $28.18 / $41.69	Facility		$8.91	$28.18	$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 $50.12 / $50.12 / $50.12	Facility		$50.12	$50.12	$50.12
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 / $38.02	Facility	TC	$5.62	$26.30	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $39.81 / $87.10	Professional		$24.55	$39.81	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.96 / $23.44	Professional	26	$6.46	$10.96	$23.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $32.36 / $70.79	Professional	TC	$18.20	$32.36	$70.79
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $128.82 / $316.23	Facility		$37.15	$128.82	$316.23
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $9.55 / $17.78	Facility	26	$9.12	$9.55	$17.78
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $50.12 / $162.18	Facility	TC	$27.54	$50.12	$162.18
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $37.15 / $89.13	Professional		$23.44	$37.15	$89.13
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $10.47 / $28.84	Professional	26	$6.92	$10.47	$28.84
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $33.11 / $66.07 / $309.03	Professional	50	$33.11	$66.07	$309.03
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $16.22 / $28.18 / $107.15	Professional	52	$16.22	$28.18	$107.15
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $27.54 / $56.23	Professional	TC	$18.62	$27.54	$56.23
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Facility		$50.12	$50.12	$50.12
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 / $38.02	Facility	TC	$5.62	$26.30	$38.02
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $30.20 / $67.61	Professional		$22.39	$30.20	$67.61
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $9.12 / $19.95	Professional	26	$5.75	$9.12	$19.95
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $22.39 / $66.07	Professional	TC	$16.60	$22.39	$66.07
United Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $70.79 / $229.09	Facility		$19.95	$70.79	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $30.90 / $48.98	Professional		$25.70	$30.90	$48.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $8.91 / $13.80	Professional	26	$7.41	$8.91	$13.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $22.39 / $35.48	Professional	TC	$18.62	$22.39	$35.48