Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $173.78 / $501.19	Facility		$45.71	$173.78	$501.19
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $37.15 / $44.67	Facility	26	$34.67	$37.15	$44.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $89.13 / $208.93	Professional		$45.71	$89.13	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $51.29 / $186.21	Professional	26	$25.70	$51.29	$186.21
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $158.49 / $467.74	Professional	50	$83.18	$158.49	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $25.12 / $66.07	Professional	TC	$14.13	$25.12	$66.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $44.67 / $85.11	Professional		$37.15	$44.67	$85.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $39.81 / $39.81	Professional	26	$39.81	$39.81	$39.81
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $54.95 / $58.88 / $141.25	Professional	50	$54.95	$58.88	$141.25
BCBS Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $44.67 / $102.33	Facility		$29.51	$44.67	$102.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $75.86 / $141.25	Professional		$70.79	$75.86	$141.25
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $47.86 / $47.86	Professional	26	$40.74	$47.86	$47.86
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	50	$151.36	$151.36	$151.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $19.50 / $38.02 / $64.57	Facility		$19.50	$38.02	$64.57
CareSource Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $36.31 / $66.07	Professional		$17.78	$36.31	$66.07
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $74.13 / $74.13	Facility		$74.13	$74.13	$74.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	26	$7.24	$33.88	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $87.10 / $173.78	Professional		$41.69	$87.10	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $47.86 / $97.72	Professional	26	$25.70	$47.86	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $37.15 / $79.43	Professional	TC	$16.60	$37.15	$79.43
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $199.53 / $457.09	Facility		$46.77	$199.53	$457.09
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $69.18 / $120.23	Facility	26	$34.67	$69.18	$120.23
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $83.18 / $173.78	Professional		$47.86	$83.18	$173.78
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $45.71 / $131.83	Professional	26	$28.84	$45.71	$131.83
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $177.83 / $346.74	Professional	50	$83.18	$177.83	$346.74
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $31.62 / $60.26	Professional	TC	$15.85	$31.62	$60.26
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $74.13 / $74.13	Facility		$74.13	$74.13	$74.13
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	26	$7.24	$33.88	$48.98
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $79.43 / $173.78	Professional		$41.69	$79.43	$173.78
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $44.67 / $93.33	Professional	26	$24.55	$44.67	$93.33
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $33.88 / $79.43	Professional	TC	$15.85	$33.88	$79.43
United Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $83.18 / $275.42	Facility		$38.02	$83.18	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $87.10 / $131.83	Professional		$51.29	$87.10	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $47.86 / $67.61	Professional	26	$30.20	$47.86	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $38.02 / $61.66	Professional	TC	$19.50	$38.02	$61.66