Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $15.49 / $19.50	Facility	26	$15.49	$15.49	$19.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $75.86 / $218.78	Professional		$45.71	$75.86	$218.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $21.88 / $53.70	Professional	26	$12.02	$21.88	$53.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $104.71	Professional	TC	$32.36	$47.86	$104.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $44.67 / $79.43	Professional		$34.67	$44.67	$79.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $12.88 / $21.88	Professional	26	$10.00	$12.88	$21.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $45.71 / $56.23	Professional	TC	$38.02	$45.71	$56.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $81.28 / $87.10	Professional		$64.57	$81.28	$87.10
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $20.89 / $28.18	Professional	26	$20.89	$20.89	$28.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $66.07 / $89.13	Professional	TC	$66.07	$66.07	$89.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $46.77 / $75.86	Professional		$14.45	$46.77	$75.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.16 / $14.79 / $21.38	Facility	26	$3.16	$14.79	$21.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $72.44 / $147.91	Professional		$41.69	$72.44	$147.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $18.62 / $38.02	Professional	26	$11.22	$18.62	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $52.48 / $114.82	Professional	TC	$28.84	$52.48	$114.82
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $15.49 / $33.88	Facility	26	$15.49	$15.49	$33.88
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $67.61 / $162.18	Professional		$45.71	$67.61	$162.18
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $17.78 / $46.77	Professional	26	$12.30	$17.78	$46.77
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $45.71 / $83.18	Professional	TC	$32.36	$45.71	$83.18
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $3.16 / $14.79 / $21.38	Facility	26	$3.16	$14.79	$21.38
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $53.70 / $114.82	Professional		$36.31	$53.70	$114.82
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $16.98 / $34.67	Professional	26	$10.00	$16.98	$34.67
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $39.81 / $112.20	Professional	TC	$26.30	$39.81	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $53.70 / $81.28	Professional		$43.65	$53.70	$81.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.85 / $25.12	Professional	26	$12.88	$15.85	$25.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $37.15 / $56.23	Professional	TC	$31.62	$37.15	$56.23