Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $16.98 / $20.89	Facility	26	$16.98	$16.98	$20.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $79.43 / $239.88	Professional		$52.48	$79.43	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $22.91 / $61.66	Professional	26	$12.02	$22.91	$61.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $53.70 / $107.15	Professional	TC	$37.15	$53.70	$107.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $52.48 / $74.13	Professional		$41.69	$52.48	$74.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $13.80 / $30.20	Professional	26	$11.48	$13.80	$30.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $53.70 / $53.70	Professional	TC	$53.70	$53.70	$53.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $93.33 / $100.00	Professional		$74.13	$93.33	$100.00
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $22.91 / $30.90	Professional	26	$22.91	$22.91	$30.90
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $75.86 / $102.33	Professional	TC	$75.86	$75.86	$102.33
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $53.70 / $87.10	Professional		$15.85	$53.70	$87.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.55 / $16.60 / $23.44	Facility	26	$3.55	$16.60	$23.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $81.28 / $169.82	Professional		$50.12	$81.28	$169.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $20.89 / $42.66	Professional	26	$12.30	$20.89	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $63.10 / $138.04	Professional	TC	$37.15	$63.10	$138.04
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $16.98 / $39.81	Facility	26	$16.98	$16.98	$39.81
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $158.49	Professional		$54.95	$74.13	$158.49
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.05 / $44.67	Professional	26	$13.80	$19.05	$44.67
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $54.95 / $95.50	Professional	TC	$39.81	$54.95	$95.50
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $3.55 / $16.60 / $23.44	Facility	26	$3.55	$16.60	$23.44
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $61.66 / $138.04	Professional		$45.71	$61.66	$138.04
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $19.05 / $39.81	Professional	26	$12.02	$19.05	$39.81
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $131.83	Professional	TC	$32.36	$47.86	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $66.07 / $95.50	Professional		$53.70	$66.07	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $18.62 / $27.54	Professional	26	$14.79	$18.62	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $46.77 / $70.79	Professional	TC	$38.02	$46.77	$70.79