Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $100.00	Facility	26	$79.43	$79.43	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $234.42 / $549.54	Professional		$151.36	$234.42	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $85.11 / $199.53	Professional	26	$56.23	$85.11	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $138.04 / $316.23	Professional	TC	$93.33	$138.04	$316.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Professional		$123.03	$123.03	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $57.54 / $100.00	Professional	26	$46.77	$57.54	$100.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $229.09 / $245.47	Professional		$138.04	$229.09	$245.47
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 $147.91 / $147.91 / $147.91	Professional	TC	$147.91	$147.91	$147.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $109.65 / $194.98	Professional		$67.61	$109.65	$194.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $100.00	Facility	26	$14.79	$69.18	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $269.15 / $478.63	Professional		$147.91	$269.15	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $177.83	Professional	26	$50.12	$75.86	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $165.96 / $316.23	Professional	TC	$91.20	$165.96	$316.23
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $83.18 / $144.54	Facility	26	$77.62	$83.18	$144.54
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $229.09 / $446.68	Professional		$162.18	$229.09	$446.68
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $173.78	Professional	26	$54.95	$77.62	$173.78
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $147.91 / $309.03	Professional	TC	$100.00	$147.91	$309.03
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $100.00	Facility	26	$14.79	$69.18	$100.00
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $223.87 / $478.63	Professional		$131.83	$223.87	$478.63
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $67.61 / $134.90	Professional	26	$46.77	$67.61	$134.90
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $151.36 / $338.84	Professional	TC	$75.86	$151.36	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $218.78 / $331.13	Professional		$154.88	$218.78	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $67.61 / $107.15	Professional	26	$56.23	$67.61	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $144.54 / $223.87	Professional	TC	$93.33	$144.54	$223.87