Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $16.60 / $85.11	Facility		$9.77	$16.60	$85.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $9.12 / $11.48	Facility	26	$8.91	$9.12	$11.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $15.14 / $47.86	Professional		$9.77	$15.14	$47.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $8.91 / $33.11	Professional	26	$6.03	$8.91	$33.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $11.48 / $11.48 / $11.48	Professional	50	$11.48	$11.48	$11.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $2.57 / $3.98 / $9.12	Professional	TC	$2.57	$3.98	$9.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $8.13 / $9.77 / $17.78	Professional		$8.13	$9.77	$17.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $10.23 / $10.23	Professional	26	$10.23	$10.23	$10.23
BCBS Facility/Professional Facility Modifier Low / Median / High Price $6.17 / $9.12 / $15.49	Facility		$6.17	$9.12	$15.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.18 / $16.98 / $16.98	Professional		$13.18	$16.98	$16.98
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Professional	26	$12.30	$12.30	$12.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3.89 / $9.55 / $15.14	Facility		$3.89	$9.55	$15.14
CareSource Facility/Professional Professional Modifier Low / Median / High Price $3.72 / $9.12 / $16.22	Professional		$3.72	$9.12	$16.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $13.80 / $16.22 / $22.39	Facility		$13.80	$16.22	$22.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.30	Facility	26	$1.86	$8.71	$12.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $15.49 / $33.88	Professional		$9.55	$15.49	$33.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.72 / $22.39	Professional	26	$6.46	$10.72	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $2.88 / $4.90 / $11.22	Professional	TC	$2.88	$4.90	$11.22
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $30.20 / $114.82	Facility		$9.77	$30.20	$114.82
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $19.05 / $22.39	Facility	26	$8.13	$19.05	$22.39
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $14.13 / $33.88	Professional		$10.00	$14.13	$33.88
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $9.12 / $17.38	Professional	26	$7.08	$9.12	$17.38
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $11.48 / $11.48 / $11.48	Professional	50	$11.48	$11.48	$11.48
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $3.02 / $4.47 / $8.13	Professional	TC	$3.02	$4.47	$8.13
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $13.80 / $16.22 / $22.39	Facility		$13.80	$16.22	$22.39
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.30	Facility	26	$1.86	$8.71	$12.30
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $13.80 / $28.84	Professional		$9.12	$13.80	$28.84
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $10.00 / $19.05	Professional	26	$6.17	$10.00	$19.05
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $2.57 / $4.68 / $10.96	Professional	TC	$2.57	$4.68	$10.96
United Facility/Professional Facility Modifier Low / Median / High Price $8.32 / $19.05 / $75.86	Facility		$8.32	$19.05	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $13.49 / $19.05	Professional		$10.96	$13.49	$19.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.55 / $13.80	Professional	26	$7.76	$9.55	$13.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $3.24 / $4.37 / $6.46	Professional	TC	$3.24	$4.37	$6.46