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 / $208.93 / $645.65	Professional		$134.90	$208.93	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $69.18 / $186.21	Professional	26	$48.98	$69.18	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $120.23 / $288.40	Professional	TC	$83.18	$120.23	$288.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $109.65	Professional		$104.71	$104.71	$109.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $48.98 / $85.11	Professional	26	$39.81	$48.98	$85.11
BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $199.53 / $213.80	Professional		$125.89	$199.53	$213.80
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $81.28 / $109.65	Professional	26	$81.28	$81.28	$109.65
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 $56.23 / $100.00 / $173.78	Professional		$56.23	$100.00	$173.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $83.18	Facility	26	$12.59	$58.88	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $245.47 / $478.63	Professional		$131.83	$245.47	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $67.61 / $151.36	Professional	26	$42.66	$67.61	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $158.49 / $302.00	Professional	TC	$79.43	$158.49	$302.00
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $66.07 / $112.20	Facility	26	$63.10	$66.07	$112.20
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $204.17 / $426.58	Professional		$141.25	$204.17	$426.58
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $66.07 / $177.83	Professional	26	$47.86	$66.07	$177.83
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $134.90 / $281.84	Professional	TC	$91.20	$134.90	$281.84
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $83.18	Facility	26	$12.59	$58.88	$83.18
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $218.78 / $478.63	Professional		$114.82	$218.78	$478.63
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $57.54 / $112.20	Professional	26	$38.90	$57.54	$112.20
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $144.54 / $275.42	Professional	TC	$69.18	$144.54	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $173.78 / $323.59	Professional		$131.83	$173.78	$323.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $57.54 / $91.20	Professional	26	$47.86	$57.54	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $109.65 / $245.47	Professional	TC	$83.18	$109.65	$245.47