Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $50.12 / $63.10	Facility	26	$50.12	$50.12	$63.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $158.49 / $354.81	Professional		$104.71	$158.49	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $57.54 / $117.49	Professional	26	$30.90	$57.54	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $102.33 / $208.93	Professional	TC	$75.86	$102.33	$208.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $107.15 / $107.15	Professional		$107.15	$107.15	$107.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $58.88 / $81.28	Professional	26	$38.02	$58.88	$81.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $204.17 / $218.78	Professional		$134.90	$204.17	$218.78
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $67.61 / $91.20	Professional	26	$67.61	$67.61	$91.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	TC	$151.36	$151.36	$151.36
CareSource Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $109.65 / $190.55	Professional		$46.77	$109.65	$190.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $47.86 / $69.18	Facility	26	$10.23	$47.86	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $169.82 / $371.54	Professional		$107.15	$169.82	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $53.70 / $123.03	Professional	26	$30.20	$53.70	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $125.89 / $281.84	Professional	TC	$75.86	$125.89	$281.84
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $52.48 / $79.43	Facility	26	$50.12	$52.48	$79.43
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $158.49 / $295.12	Professional		$107.15	$158.49	$295.12
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $50.12 / $104.71	Professional	26	$30.20	$50.12	$104.71
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $107.15 / $199.53	Professional	TC	$77.62	$107.15	$199.53
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $47.86 / $69.18	Facility	26	$10.23	$47.86	$69.18
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $134.90 / $295.12	Professional		$102.33	$134.90	$295.12
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $43.65 / $112.20	Professional	26	$27.54	$43.65	$112.20
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $93.33 / $263.03	Professional	TC	$70.79	$93.33	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $134.90 / $208.93	Professional		$109.65	$134.90	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $42.66 / $67.61	Professional	26	$32.36	$42.66	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $95.50 / $141.25	Professional	TC	$79.43	$95.50	$141.25