Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $1,288.25	Facility	26	$112.20	$112.20	$1,288.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $416.87 / $1,548.82	Professional		$281.84	$416.87	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $114.82 / $338.84	Professional	26	$81.28	$114.82	$338.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $281.84 / $616.60	Professional	TC	$213.80	$281.84	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $275.42 / $295.12	Professional		$223.87	$275.42	$295.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $83.18 / $138.04	Professional	26	$64.57	$83.18	$138.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $302.00 / $323.59	Professional	TC	$194.98	$302.00	$323.59
BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $457.09 / $489.78	Professional		$331.13	$457.09	$489.78
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $138.04 / $186.21	Professional	26	$138.04	$138.04	$186.21
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $354.81 / $354.81	Professional	TC	$354.81	$354.81	$354.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $251.19 / $426.58	Professional		$95.50	$251.19	$426.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.38 / $97.72 / $141.25	Facility	26	$21.38	$97.72	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $416.87 / $933.25	Professional		$257.04	$416.87	$933.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $109.65 / $251.19	Professional	26	$72.44	$109.65	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $309.03 / $676.08	Professional	TC	$186.21	$309.03	$676.08
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $204.17	Facility	26	$112.20	$112.20	$204.17
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $389.05 / $1,000.00	Professional		$281.84	$389.05	$1,000.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $120.23 / $354.81	Professional	26	$81.28	$120.23	$354.81
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $281.84 / $512.86	Professional	TC	$213.80	$281.84	$512.86
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $21.38 / $97.72 / $141.25	Facility	26	$21.38	$97.72	$141.25
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $323.59 / $758.58	Professional		$251.19	$323.59	$758.58
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $93.33 / $190.55	Professional	26	$67.61	$93.33	$190.55
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $229.09 / $602.56	Professional	TC	$173.78	$229.09	$602.56
United Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $363.08 / $537.03	Professional		$288.40	$363.08	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $151.36	Professional	26	$81.28	$100.00	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $263.03 / $398.11	Professional	TC	$208.93	$263.03	$398.11