Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $77.62 / $97.72	Facility	26	$77.62	$77.62	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $630.96	Professional		$169.82	$275.42	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $85.11 / $208.93	Professional	26	$54.95	$85.11	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $173.78 / $380.19	Professional	TC	$114.82	$173.78	$380.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $162.18	Professional		$138.04	$138.04	$162.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $57.54 / $97.72	Professional	26	$44.67	$57.54	$97.72
BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $263.03 / $281.84	Professional		$173.78	$263.03	$281.84
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $95.50 / $128.82	Professional	26	$95.50	$95.50	$128.82
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $186.21 / $186.21	Professional	TC	$186.21	$186.21	$186.21
CareSource Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $134.90 / $234.42	Professional		$66.07	$134.90	$234.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $309.03 / $575.44	Professional		$169.82	$309.03	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $83.18 / $173.78	Professional	26	$50.12	$83.18	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $208.93 / $398.11	Professional	TC	$112.20	$208.93	$398.11
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $77.62 / $134.90	Facility	26	$74.13	$77.62	$134.90
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $263.03 / $562.34	Professional		$186.21	$263.03	$562.34
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $177.83	Professional	26	$54.95	$77.62	$177.83
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $177.83 / $371.54	Professional	TC	$125.89	$177.83	$371.54
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $251.19 / $478.63	Professional		$151.36	$251.19	$478.63
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $131.83	Professional	26	$45.71	$66.07	$131.83
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $190.55 / $354.81	Professional	TC	$97.72	$190.55	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $234.42 / $398.11	Professional		$173.78	$234.42	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $67.61 / $104.71	Professional	26	$56.23	$67.61	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $154.88 / $302.00	Professional	TC	$114.82	$154.88	$302.00