Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $190.55 / $467.74	Facility		$91.20	$190.55	$467.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $48.98	Facility	26	$38.90	$38.90	$48.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $117.49 / $436.52	Professional		$57.54	$117.49	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $61.66 / $186.21	Professional	26	$30.20	$61.66	$186.21
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $77.62 / $218.78 / $724.44	Professional	50	$77.62	$218.78	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $61.66 / $251.19	Professional	TC	$43.65	$61.66	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $77.62 / $147.91	Professional		$61.66	$77.62	$147.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $41.69 / $58.88	Professional	26	$25.70	$41.69	$58.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $93.33 / $100.00 / $229.09	Professional	50	$93.33	$100.00	$229.09
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $47.86 / $72.44	Professional	TC	$36.31	$47.86	$72.44
BCBS Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $128.82 / $239.88	Facility		$87.10	$128.82	$239.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $134.90 / $251.19	Professional		$125.89	$134.90	$251.19
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Professional	26	$51.29	$51.29	$51.29
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $269.15 / $269.15 / $269.15	Professional	50	$269.15	$269.15	$269.15
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $83.18 / $83.18	Professional	TC	$70.79	$83.18	$83.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $61.66 / $112.20	Facility		$37.15	$61.66	$112.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $61.66 / $104.71	Professional		$36.31	$61.66	$104.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Facility		$131.83	$131.83	$131.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $104.71 / $234.42	Professional		$67.61	$104.71	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $40.74 / $95.50	Professional	26	$26.30	$40.74	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $67.61 / $151.36	Professional	TC	$43.65	$67.61	$151.36
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $204.17 / $478.63	Facility		$97.72	$204.17	$478.63
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $69.18	Facility	26	$38.90	$38.90	$69.18
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $104.71 / $316.23	Professional		$67.61	$104.71	$316.23
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $43.65 / $125.89	Professional	26	$28.84	$43.65	$125.89
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $89.13 / $229.09 / $724.44	Professional	50	$89.13	$229.09	$724.44
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $60.26 / $128.82	Professional	TC	$42.66	$60.26	$128.82
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Facility		$131.83	$131.83	$131.83
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $93.33 / $181.97	Professional		$64.57	$93.33	$181.97
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $37.15 / $70.79	Professional	26	$25.70	$37.15	$70.79
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $57.54 / $109.65	Professional	TC	$39.81	$57.54	$109.65
United Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $79.43 / $229.09	Facility		$60.26	$79.43	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $95.50 / $131.83	Professional		$77.62	$95.50	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $38.02 / $51.29	Professional	26	$30.90	$38.02	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $57.54 / $81.28	Professional	TC	$46.77	$57.54	$81.28