Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $28.84 / $58.88 / $251.19	Facility		$28.84	$58.88	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $40.74 / $141.25	Professional		$22.91	$40.74	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $15.49 / $51.29	Professional	26	$5.01	$15.49	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $28.84 / $67.61	Professional	TC	$15.85	$28.84	$67.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $3.31 / $6.76 / $9.12	Professional	26	$3.31	$6.76	$9.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $53.70 / $54.95	Professional		$39.81	$53.70	$54.95
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $10.72 / $14.45	Professional	26	$10.72	$10.72	$14.45
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $42.66 / $57.54	Professional	TC	$42.66	$42.66	$57.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $6.31 / $30.20 / $79.43	Facility		$6.31	$30.20	$79.43
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.41 / $29.51 / $53.70	Professional		$7.41	$29.51	$53.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $64.57	Facility		$53.70	$53.70	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $42.66 / $128.82	Professional		$14.45	$42.66	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.47 / $9.33 / $28.18	Professional	26	$3.47	$9.33	$28.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $19.95 / $57.54	Professional	TC	$10.47	$19.95	$57.54
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $28.84 / $181.97 / $251.19	Facility		$28.84	$181.97	$251.19
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $45.71 / $85.11	Professional		$25.70	$45.71	$85.11
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $9.12 / $50.12	Professional	26	$5.62	$9.12	$50.12
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $32.36 / $66.07	Professional	TC	$19.95	$32.36	$66.07
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $64.57	Facility		$53.70	$53.70	$64.57
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $15.49 / $69.18	Professional		$14.13	$15.49	$69.18
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2.88 / $3.55 / $21.38	Professional	26	$2.88	$3.55	$21.38
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.23 / $11.48 / $36.31	Professional	TC	$10.23	$11.48	$36.31
United Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $32.36 / $53.70	Professional		$19.05	$32.36	$53.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.27 / $6.61 / $10.00	Professional	26	$4.27	$6.61	$10.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $26.30 / $45.71	Professional	TC	$14.45	$26.30	$45.71