Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $107.15 / $134.90	Facility	26	$102.33	$107.15	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $389.05 / $1,288.25	Professional		$251.19	$389.05	$1,288.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $107.15 / $275.42	Professional	26	$77.62	$107.15	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $234.42 / $537.03	Professional	TC	$169.82	$234.42	$537.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $239.88	Professional		$223.87	$223.87	$239.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $81.28 / $144.54	Professional	26	$63.10	$81.28	$144.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $416.87 / $446.68	Professional		$338.84	$416.87	$446.68
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $131.83 / $177.83	Professional	26	$131.83	$131.83	$177.83
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $316.23 / $316.23	Professional	TC	$316.23	$316.23	$316.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $229.09 / $389.05	Professional		$91.20	$229.09	$389.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $134.90	Facility	26	$19.95	$93.33	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $478.63 / $977.24	Professional		$269.15	$478.63	$977.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $104.71 / $245.47	Professional	26	$69.18	$104.71	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $338.84 / $812.83	Professional	TC	$190.55	$338.84	$812.83
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $107.15 / $181.97	Facility	26	$102.33	$107.15	$181.97
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $776.25	Professional		$275.42	$426.58	$776.25
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $107.15 / $281.84	Professional	26	$77.62	$107.15	$281.84
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $295.12 / $537.03	Professional	TC	$186.21	$295.12	$537.03
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $134.90	Facility	26	$19.95	$93.33	$134.90
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $389.05 / $1,000.00	Professional		$239.88	$389.05	$1,000.00
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $89.13 / $181.97	Professional	26	$63.10	$89.13	$181.97
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $269.15 / $812.83	Professional	TC	$165.96	$269.15	$812.83
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $416.87 / $660.69	Professional		$275.42	$416.87	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $91.20 / $144.54	Professional	26	$77.62	$91.20	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $309.03 / $562.34	Professional	TC	$194.98	$309.03	$562.34