Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $147.91 / $389.05	Facility		$47.86	$147.91	$389.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $12.59	Facility	26	$10.00	$10.00	$12.59
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $75.86 / $263.03	Facility	TC	$31.62	$75.86	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $42.66 / $120.23	Professional		$11.22	$42.66	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $17.38 / $52.48	Professional	26	$7.94	$17.38	$52.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.48 / $91.20 / $204.17	Professional	50	$35.48	$91.20	$204.17
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $29.51 / $29.51 / $97.72	Professional	52	$29.51	$29.51	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $41.69 / $89.13	Professional	TC	$21.88	$41.69	$89.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $30.20 / $51.29	Professional		$24.55	$30.20	$51.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.51 / $15.85	Professional	26	$6.46	$8.51	$15.85
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $58.88 / $87.10	Professional	50	$41.69	$58.88	$87.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.18 / $40.74	Professional	TC	$19.05	$28.18	$40.74
BCBS Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $69.18 / $117.49	Facility		$46.77	$69.18	$117.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $57.54 / $109.65	Professional		$41.69	$57.54	$109.65
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $13.18 / $17.78	Professional	26	$13.18	$13.18	$17.78
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $114.82 / $114.82 / $144.54	Professional	50	$114.82	$114.82	$144.54
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $60.26	Professional	TC	$44.67	$44.67	$60.26
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $32.36 / $47.86	Facility		$9.77	$32.36	$47.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $31.62 / $50.12	Professional		$9.33	$31.62	$50.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $54.95 / $75.86	Facility		$52.48	$54.95	$75.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	TC	$6.46	$30.20	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $43.65 / $97.72	Professional		$28.18	$43.65	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $11.75 / $24.55	Professional	26	$6.92	$11.75	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $35.48 / $83.18	Professional	TC	$20.89	$35.48	$83.18
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $169.82 / $389.05	Facility		$46.77	$169.82	$389.05
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $18.62	Facility	26	$10.00	$10.00	$18.62
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $87.10 / $275.42	Facility	TC	$31.62	$87.10	$275.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $43.65 / $114.82	Professional		$18.62	$43.65	$114.82
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.59 / $52.48	Professional	26	$7.59	$12.59	$52.48
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $35.48 / $112.20 / $288.40	Professional	50	$35.48	$112.20	$288.40
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $29.51 / $29.51 / $97.72	Professional	52	$29.51	$29.51	$97.72
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $33.88 / $75.86	Professional	TC	$21.88	$33.88	$75.86
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $54.95 / $75.86	Facility		$52.48	$54.95	$75.86
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	TC	$6.46	$30.20	$43.65
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $33.11 / $77.62	Professional		$25.12	$33.11	$77.62
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $9.55 / $21.38	Professional	26	$6.03	$9.55	$21.38
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $26.30 / $75.86	Professional	TC	$19.50	$26.30	$75.86
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 $29.51 / $35.48 / $53.70	Professional		$29.51	$35.48	$53.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.33 / $14.45	Professional	26	$7.94	$9.33	$14.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $25.12 / $39.81	Professional	TC	$21.38	$25.12	$39.81