Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $107.15 / $213.80	Facility		$35.48	$107.15	$213.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $10.23 / $13.18	Facility	26	$10.23	$10.23	$13.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $31.62 / $162.18	Facility	TC	$23.99	$31.62	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $43.65 / $117.49	Professional		$24.55	$43.65	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.59 / $45.71	Professional	26	$7.94	$12.59	$45.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $25.12 / $57.54	Professional	TC	$16.60	$25.12	$57.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $25.12 / $35.48	Professional		$19.05	$25.12	$35.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.51 / $14.13	Professional	26	$6.46	$8.51	$14.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $20.42 / $28.18	Professional	TC	$16.22	$20.42	$28.18
BCBS Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $52.48 / $91.20	Facility		$35.48	$52.48	$91.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $44.67 / $47.86	Professional		$31.62	$44.67	$47.86
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $13.80 / $13.80	Professional	26	$13.80	$13.80	$13.80
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	TC	$33.88	$33.88	$33.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.23 / $25.70 / $38.90	Facility		$10.23	$25.70	$38.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $24.55 / $41.69	Professional		$9.55	$24.55	$41.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $46.77 / $63.10	Facility		$46.77	$46.77	$63.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.11	Facility	TC	$5.01	$23.44	$33.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $36.31 / $81.28	Professional		$23.44	$36.31	$81.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $12.30 / $25.70	Professional	26	$7.41	$12.30	$25.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $27.54 / $61.66	Professional	TC	$16.60	$27.54	$61.66
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $107.15 / $223.87	Facility		$34.67	$107.15	$223.87
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $10.23 / $17.78	Facility	26	$10.23	$10.23	$17.78
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $33.11 / $194.98	Facility	TC	$23.99	$33.11	$194.98
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $35.48 / $91.20	Professional		$23.99	$35.48	$91.20
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $11.48 / $42.66	Professional	26	$7.94	$11.48	$42.66
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.99 / $48.98	Professional	TC	$15.85	$23.99	$48.98
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $46.77 / $63.10	Facility		$46.77	$46.77	$63.10
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.11	Facility	TC	$5.01	$23.44	$33.11
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $28.84 / $64.57	Professional		$22.39	$28.84	$64.57
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.00 / $22.39	Professional	26	$6.76	$10.00	$22.39
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $20.89 / $58.88	Professional	TC	$14.79	$20.89	$58.88
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 $25.12 / $30.20 / $44.67	Professional		$25.12	$30.20	$44.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.00 / $15.14	Professional	26	$8.32	$10.00	$15.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $19.95 / $30.20	Professional	TC	$16.60	$19.95	$30.20