Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $91.20 / $114.82	Facility	26	$89.13	$91.20	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $426.58 / $1,230.27	Professional		$194.98	$426.58	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $125.89 / $371.54	Professional	26	$67.61	$125.89	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $234.42 / $562.34	Professional	TC	$125.89	$234.42	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $158.49 / $263.03	Professional		$70.79	$158.49	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $114.82	Professional	26	$52.48	$66.07	$114.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $123.03 / $141.25	Professional	TC	$93.33	$123.03	$141.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $288.40 / $309.03	Professional		$186.21	$288.40	$309.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $151.36	Professional	26	$112.20	$112.20	$151.36
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	TC	$199.53	$199.53	$199.53
CareSource Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $147.91 / $251.19	Professional		$77.62	$147.91	$251.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $416.87 / $812.83	Professional		$190.55	$416.87	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $97.72 / $204.17	Professional	26	$58.88	$97.72	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $263.03 / $602.56	Professional	TC	$125.89	$263.03	$602.56
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $91.20 / $169.82	Facility	26	$85.11	$91.20	$169.82
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $371.54 / $831.76	Professional		$213.80	$371.54	$831.76
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $338.84	Professional	26	$69.18	$112.20	$338.84
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $263.03 / $489.78	Professional	TC	$134.90	$263.03	$489.78
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $363.08 / $812.83	Professional		$165.96	$363.08	$812.83
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $83.18 / $169.82	Professional	26	$53.70	$83.18	$169.82
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $234.42 / $602.56	Professional	TC	$107.15	$234.42	$602.56
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $269.15 / $616.60	Professional		$199.53	$269.15	$616.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $83.18 / $123.03	Professional	26	$66.07	$83.18	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $173.78 / $501.19	Professional	TC	$128.82	$173.78	$501.19