Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $154.88 / $177.83	Facility		$67.61	$154.88	$177.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $36.31 / $43.65	Facility	26	$33.88	$36.31	$43.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $77.62 / $234.42	Professional		$39.81	$77.62	$234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $37.15 / $95.50	Professional	26	$27.54	$37.15	$95.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $54.95 / $123.03 / $331.13	Professional	50	$54.95	$123.03	$331.13
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.22 / $16.22 / $20.89	Professional	52	$16.22	$16.22	$20.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $37.15 / $131.83	Professional	TC	$15.85	$37.15	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $43.65 / $64.57	Professional		$42.66	$43.65	$64.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $28.84 / $45.71	Professional	26	$25.70	$28.84	$45.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $19.05 / $54.95	Professional	TC	$14.45	$19.05	$54.95
BCBS Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $83.18 / $158.49	Facility		$35.48	$83.18	$158.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $70.79 / $194.98	Professional		$44.67	$70.79	$194.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $37.15 / $63.10	Facility		$19.05	$37.15	$63.10
CareSource Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $35.48 / $66.07	Professional		$17.38	$35.48	$66.07
Cigna Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $89.13 / $141.25	Facility		$70.79	$89.13	$141.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $47.86	Facility	26	$7.24	$33.88	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $83.18 / $162.18	Professional		$42.66	$83.18	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $38.02 / $87.10	Professional	26	$26.30	$38.02	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $39.81 / $93.33	Professional	TC	$16.22	$39.81	$93.33
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $154.88 / $229.09	Facility		$56.23	$154.88	$229.09
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $43.65 / $85.11	Facility	26	$33.88	$43.65	$85.11
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $81.28 / $158.49	Professional		$44.67	$81.28	$158.49
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $35.48 / $72.44	Professional	26	$28.18	$35.48	$72.44
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $56.23 / $162.18 / $331.13	Professional	50	$56.23	$162.18	$331.13
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $16.22 / $16.22 / $20.89	Professional	52	$16.22	$16.22	$20.89
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $43.65 / $87.10	Professional	TC	$17.78	$43.65	$87.10
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $89.13 / $141.25	Facility		$70.79	$89.13	$141.25
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $47.86	Facility	26	$7.24	$33.88	$47.86
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $79.43 / $147.91	Professional		$38.90	$79.43	$147.91
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $33.11 / $61.66	Professional	26	$23.44	$33.11	$61.66
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $38.90 / $77.62	Professional	TC	$15.14	$38.90	$77.62
United Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $177.83 / $426.58	Facility		$31.62	$177.83	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $81.28 / $112.20	Professional		$56.23	$81.28	$112.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $33.11 / $46.77	Professional	26	$26.92	$33.11	$46.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $50.12 / $70.79	Professional	TC	$23.99	$50.12	$70.79