Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $151.36 / $302.00	Facility		$53.70	$151.36	$302.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $25.70 / $30.90	Facility	26	$23.99	$25.70	$30.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.05 / $112.20 / $275.42	Facility	TC	$19.05	$112.20	$275.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $70.79 / $134.90	Professional		$33.88	$70.79	$134.90
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $70.79 / $70.79 / $70.79	Professional	25	$70.79	$70.79	$70.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $26.30 / $66.07	Professional	26	$17.38	$26.30	$66.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $89.13 / $234.42 / $338.84	Professional	50	$89.13	$234.42	$338.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $38.02 / $151.36	Professional	52	$30.20	$38.02	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $26.30 / $95.50	Professional	TC	$14.13	$26.30	$95.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $34.67 / $53.70	Professional		$32.36	$34.67	$53.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $26.92 / $26.92	Professional	26	$26.92	$26.92	$26.92
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $8.32 / $8.32 / $8.32	Professional	52	$8.32	$8.32	$8.32
BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $83.18 / $165.96	Facility		$39.81	$83.18	$165.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $154.88 / $165.96	Professional		$30.20	$154.88	$165.96
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Professional	26	$32.36	$32.36	$32.36
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $26.30 / $26.30	Professional	TC	$26.30	$26.30	$26.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $16.22 / $25.70 / $50.12	Facility		$16.22	$25.70	$50.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $26.30 / $46.77	Professional		$16.60	$26.30	$46.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $77.62 / $109.65	Facility		$57.54	$77.62	$109.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.01 / $22.91 / $33.11	Facility	26	$5.01	$22.91	$33.11
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $3.80 / $17.78 / $25.12	Facility	TC	$3.80	$17.78	$25.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $70.79 / $144.54	Professional		$33.88	$70.79	$144.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $28.84 / $66.07	Professional	26	$18.20	$28.84	$66.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $38.02 / $91.20	Professional	TC	$15.85	$38.02	$91.20
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $154.88 / $239.88	Facility		$53.70	$154.88	$239.88
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $56.23 / $66.07	Facility	26	$23.99	$56.23	$66.07
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $22.91 / $208.93 / $275.42	Facility	TC	$22.91	$208.93	$275.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $72.44 / $123.03	Professional		$35.48	$72.44	$123.03
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $70.79 / $70.79 / $70.79	Professional	25	$70.79	$70.79	$70.79
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $25.12 / $60.26	Professional	26	$19.95	$25.12	$60.26
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $89.13 / $234.42 / $338.84	Professional	50	$89.13	$234.42	$338.84
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $38.02 / $151.36	Professional	52	$30.20	$38.02	$151.36
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $38.90 / $81.28	Professional	TC	$15.49	$38.90	$81.28
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $77.62 / $109.65	Facility		$57.54	$77.62	$109.65
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $5.01 / $22.91 / $33.11	Facility	26	$5.01	$22.91	$33.11
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $3.80 / $17.78 / $25.12	Facility	TC	$3.80	$17.78	$25.12
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $67.61 / $151.36	Professional		$33.11	$67.61	$151.36
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $25.70 / $69.18	Professional	26	$17.78	$25.70	$69.18
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $37.15 / $95.50	Professional	TC	$14.79	$37.15	$95.50
United Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $213.80 / $426.58	Facility		$44.67	$213.80	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $69.18 / $97.72	Professional		$41.69	$69.18	$97.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $24.55 / $35.48	Professional	26	$19.50	$24.55	$35.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $44.67 / $63.10	Professional	TC	$20.89	$44.67	$63.10