Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $56.23 / $70.79	Facility	26	$56.23	$56.23	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $213.80 / $645.65	Professional		$109.65	$213.80	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $87.10 / $239.88	Professional	26	$42.66	$87.10	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $91.20 / $281.84	Professional	TC	$60.26	$91.20	$281.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $112.20 / $208.93	Professional		$81.28	$112.20	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.12 / $89.13	Professional	26	$37.15	$50.12	$89.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $69.18 / $87.10	Professional	TC	$56.23	$69.18	$87.10
BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $173.78 / $186.21	Professional		$104.71	$173.78	$186.21
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $74.13 / $74.13	Professional	26	$74.13	$74.13	$74.13
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $112.20	Professional	TC	$112.20	$112.20	$112.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $83.18 / $144.54	Professional		$52.48	$83.18	$144.54
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 $100.00 / $147.91 / $323.59	Professional		$100.00	$147.91	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $58.88 / $134.90	Professional	26	$38.02	$58.88	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $93.33 / $204.17	Professional	TC	$57.54	$93.33	$204.17
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $56.23 / $100.00	Facility	26	$56.23	$56.23	$100.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $162.18 / $478.63	Professional		$109.65	$162.18	$478.63
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $61.66 / $165.96	Professional	26	$41.69	$61.66	$165.96
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $87.10 / $165.96	Professional	TC	$64.57	$87.10	$165.96
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 $93.33 / $128.82 / $275.42	Professional		$93.33	$128.82	$275.42
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $52.48 / $102.33	Professional	26	$33.11	$52.48	$102.33
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $79.43 / $169.82	Professional	TC	$57.54	$79.43	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $138.04 / $186.21	Professional		$109.65	$138.04	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $52.48 / $74.13	Professional	26	$43.65	$52.48	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $81.28 / $109.65	Professional	TC	$66.07	$81.28	$109.65