Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $66.07 / $83.18	Facility	26	$63.10	$66.07	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $177.83 / $512.86	Professional		$134.90	$177.83	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $72.44 / $190.55	Professional	26	$47.86	$72.44	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $109.65 / $223.87	Professional	TC	$87.10	$109.65	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $109.65 / $134.90	Professional		$102.33	$109.65	$134.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $48.98 / $83.18	Professional	26	$38.90	$48.98	$83.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $79.43 / $128.82	Professional	TC	$79.43	$79.43	$128.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $208.93 / $223.87	Professional		$131.83	$208.93	$223.87
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	26	$81.28	$81.28	$81.28
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $141.25 / $141.25	Professional	TC	$141.25	$141.25	$141.25
CareSource Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $107.15 / $177.83	Professional		$56.23	$107.15	$177.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $57.54 / $83.18	Facility	26	$12.59	$57.54	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $204.17 / $416.87	Professional		$123.03	$204.17	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $64.57 / $151.36	Professional	26	$42.66	$64.57	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $125.89 / $263.03	Professional	TC	$79.43	$125.89	$263.03
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $66.07 / $107.15	Facility	26	$63.10	$66.07	$107.15
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $177.83 / $389.05	Professional		$128.82	$177.83	$389.05
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $177.83	Professional	26	$45.71	$66.07	$177.83
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $109.65 / $208.93	Professional	TC	$81.28	$109.65	$208.93
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $57.54 / $83.18	Facility	26	$12.59	$57.54	$83.18
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $177.83 / $316.23	Professional		$114.82	$177.83	$316.23
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $54.95 / $134.90	Professional	26	$38.90	$54.95	$134.90
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $102.33 / $245.47	Professional	TC	$70.79	$102.33	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $165.96 / $245.47	Professional		$134.90	$165.96	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $57.54 / $89.13	Professional	26	$46.77	$57.54	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $107.15 / $154.88	Professional	TC	$87.10	$107.15	$154.88