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 / $63.10	Facility	26	$60.26	$60.26	$63.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $165.96 / $562.34	Professional		$50.12	$165.96	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $81.28 / $257.04	Professional	26	$44.67	$81.28	$257.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $177.83 / $194.98 / $954.99	Professional	50	$177.83	$194.98	$954.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $131.83 / $331.13	Professional	TC	$83.18	$131.83	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $104.71 / $131.83	Professional		$95.50	$104.71	$131.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $45.71 / $89.13	Professional	26	$35.48	$45.71	$89.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $97.72 / $114.82	Professional	TC	$97.72	$97.72	$114.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $208.93 / $389.05	Professional		$125.89	$208.93	$389.05
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 50 Low / Median / High Price $416.87 / $416.87 / $562.34	Professional	50	$416.87	$416.87	$562.34
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 / $239.88 / $426.58	Professional		$138.04	$239.88	$426.58
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 / $309.03	Professional	TC	$91.20	$162.18	$309.03
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $60.26 / $107.15	Facility	26	$58.88	$60.26	$107.15
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $204.17 / $501.19	Professional		$102.33	$204.17	$501.19
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $64.57 / $218.78	Professional	26	$44.67	$64.57	$218.78
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $194.98 / $467.74 / $1,513.56	Professional	50	$194.98	$467.74	$1,513.56
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $144.54 / $302.00	Professional	TC	$91.20	$144.54	$302.00
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 / $213.80 / $446.68	Professional		$112.20	$213.80	$446.68
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $56.23 / $107.15	Professional	26	$37.15	$56.23	$107.15
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $151.36 / $309.03	Professional	TC	$70.79	$151.36	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $204.17 / $316.23	Professional		$141.25	$204.17	$316.23
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 / $234.42	Professional	TC	$95.50	$144.54	$234.42