Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $107.15	Facility	26	$85.11	$85.11	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $363.08 / $1,148.15	Professional		$229.09	$363.08	$1,148.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $91.20 / $229.09	Professional	26	$61.66	$91.20	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $239.88 / $549.54	Professional	TC	$169.82	$239.88	$549.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $208.93 / $239.88	Professional		$194.98	$208.93	$239.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $63.10 / $109.65	Professional	26	$54.95	$63.10	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $389.05 / $416.87	Professional		$295.12	$389.05	$416.87
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $104.71 / $141.25	Professional	26	$104.71	$104.71	$141.25
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $316.23 / $316.23	Professional	TC	$316.23	$316.23	$316.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $229.09 / $363.08	Professional		$72.44	$229.09	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $107.15	Facility	26	$16.22	$75.86	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $416.87 / $812.83	Professional		$245.47	$416.87	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $87.10 / $190.55	Professional	26	$54.95	$87.10	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $316.23 / $616.60	Professional	TC	$181.97	$316.23	$616.60
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $85.11 / $147.91	Facility	26	$81.28	$85.11	$147.91
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $363.08 / $724.44	Professional		$257.04	$363.08	$724.44
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $85.11 / $190.55	Professional	26	$60.26	$85.11	$190.55
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $275.42 / $501.19	Professional	TC	$186.21	$275.42	$501.19
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $107.15	Facility	26	$16.22	$75.86	$107.15
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $316.23 / $707.95	Professional		$218.78	$316.23	$707.95
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $72.44 / $147.91	Professional	26	$51.29	$72.44	$147.91
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $251.19 / $549.54	Professional	TC	$165.96	$251.19	$549.54
United Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $323.59 / $549.54	Professional		$251.19	$323.59	$549.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $74.13 / $117.49	Professional	26	$61.66	$74.13	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $245.47 / $426.58	Professional	TC	$181.97	$245.47	$426.58