Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $75.86 / $95.50	Facility	26	$75.86	$75.86	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $288.40 / $676.08	Professional		$194.98	$288.40	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $77.62 / $208.93	Professional	26	$56.23	$77.62	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $213.80 / $436.52	Professional	TC	$134.90	$213.80	$436.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $177.83	Professional		$147.91	$147.91	$177.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $56.23 / $128.82	Professional	26	$43.65	$56.23	$128.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	TC	$204.17	$204.17	$204.17
BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $316.23	Professional		$208.93	$295.12	$316.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $125.89	Professional	26	$93.33	$93.33	$125.89
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $223.87 / $302.00	Professional	TC	$223.87	$223.87	$302.00
CareSource Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $165.96 / $245.47	Professional		$60.26	$165.96	$245.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $371.54 / $707.95	Professional		$204.17	$371.54	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $83.18 / $169.82	Professional	26	$50.12	$83.18	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $263.03 / $512.86	Professional	TC	$141.25	$263.03	$512.86
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $75.86 / $154.88	Facility	26	$75.86	$75.86	$154.88
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $316.23 / $630.96	Professional		$208.93	$316.23	$630.96
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $75.86 / $181.97	Professional	26	$56.23	$75.86	$181.97
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $234.42 / $436.52	Professional	TC	$151.36	$234.42	$436.52
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $295.12 / $676.08	Professional		$169.82	$295.12	$676.08
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $72.44 / $144.54	Professional	26	$46.77	$72.44	$144.54
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $208.93 / $512.86	Professional	TC	$117.49	$208.93	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $309.03 / $489.78	Professional		$213.80	$309.03	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $114.82	Professional	26	$60.26	$70.79	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $229.09 / $380.19	Professional	TC	$151.36	$229.09	$380.19