Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $60.26 / $75.86	Facility	26	$60.26	$60.26	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $213.80 / $562.34	Professional		$131.83	$213.80	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $67.61 / $186.21	Professional	26	$43.65	$67.61	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $125.89 / $316.23	Professional	TC	$85.11	$125.89	$316.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $104.71	Professional		$97.72	$97.72	$104.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.71 / $89.13	Professional	26	$34.67	$45.71	$89.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	TC	$109.65	$109.65	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $194.98 / $208.93	Professional		$125.89	$194.98	$208.93
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $74.13 / $100.00	Professional	26	$74.13	$74.13	$100.00
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $134.90 / $181.97	Professional	TC	$134.90	$134.90	$181.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $102.33 / $169.82	Professional		$52.48	$102.33	$169.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $251.19 / $467.74	Professional		$138.04	$251.19	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $66.07 / $134.90	Professional	26	$39.81	$66.07	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $162.18 / $323.59	Professional	TC	$91.20	$162.18	$323.59
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $60.26 / $104.71	Facility	26	$58.88	$60.26	$104.71
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $213.80 / $436.52	Professional		$141.25	$213.80	$436.52
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $61.66 / $169.82	Professional	26	$43.65	$61.66	$169.82
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $144.54 / $309.03	Professional	TC	$91.20	$144.54	$309.03
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $223.87 / $467.74	Professional		$112.20	$223.87	$467.74
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $56.23 / $104.71	Professional	26	$37.15	$56.23	$104.71
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $158.49 / $309.03	Professional	TC	$70.79	$158.49	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $208.93 / $331.13	Professional		$141.25	$208.93	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $56.23 / $83.18	Professional	26	$44.67	$56.23	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $144.54 / $251.19	Professional	TC	$95.50	$144.54	$251.19