Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $70.79 / $89.13	Facility	26	$67.61	$70.79	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $208.93 / $501.19	Professional		$109.65	$208.93	$501.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $95.50 / $213.80	Professional	26	$52.48	$95.50	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $173.78 / $371.54	Professional	TC	$114.82	$173.78	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $147.91	Professional		$147.91	$147.91	$147.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $91.20	Professional	26	$41.69	$51.29	$91.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $269.15 / $501.19	Professional		$251.19	$269.15	$501.19
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $87.10 / $117.49	Professional	26	$87.10	$87.10	$117.49
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	TC	$181.97	$181.97	$181.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $131.83 / $229.09	Professional		$60.26	$131.83	$229.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $295.12 / $549.54	Professional		$169.82	$295.12	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $75.86 / $158.49	Professional	26	$45.71	$75.86	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $213.80 / $407.38	Professional	TC	$117.49	$213.80	$407.38
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $70.79 / $131.83	Facility	26	$67.61	$70.79	$131.83
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $251.19 / $512.86	Professional		$162.18	$251.19	$512.86
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $72.44 / $194.98	Professional	26	$50.12	$72.44	$194.98
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $190.55 / $380.19	Professional	TC	$123.03	$190.55	$380.19
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $251.19 / $562.34	Professional		$144.54	$251.19	$562.34
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $60.26 / $123.03	Professional	26	$41.69	$60.26	$123.03
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $173.78 / $416.87	Professional	TC	$95.50	$173.78	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $257.04 / $389.05	Professional		$181.97	$257.04	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $61.66 / $95.50	Professional	26	$51.29	$61.66	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $186.21 / $295.12	Professional	TC	$123.03	$186.21	$295.12