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 $125.89 / $234.42 / $691.83	Professional		$125.89	$234.42	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $91.20 / $223.87	Professional	26	$42.66	$91.20	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $112.20 / $251.19	Professional	TC	$74.13	$112.20	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $128.82 / $223.87	Professional		$93.33	$128.82	$223.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $51.29 / $85.11	Professional	26	$38.02	$51.29	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $100.00 / $147.91	Professional	TC	$50.12	$100.00	$147.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $199.53 / $213.80	Professional		$128.82	$199.53	$213.80
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $75.86 / $93.33	Professional	26	$75.86	$75.86	$93.33
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $138.04 / $138.04	Professional	TC	$117.49	$138.04	$138.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $104.71 / $173.78	Professional		$52.48	$104.71	$173.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $77.62	Facility	26	$11.48	$53.70	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $165.96 / $371.54	Professional		$109.65	$165.96	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $60.26 / $138.04	Professional	26	$38.02	$60.26	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $109.65 / $257.04	Professional	TC	$74.13	$109.65	$257.04
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $56.23 / $102.33	Facility	26	$56.23	$56.23	$102.33
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $186.21 / $457.09	Professional		$125.89	$186.21	$457.09
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $63.10 / $169.82	Professional	26	$41.69	$63.10	$169.82
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $107.15 / $190.55	Professional	TC	$81.28	$107.15	$190.55
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $77.62	Facility	26	$11.48	$53.70	$77.62
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $147.91 / $316.23	Professional		$102.33	$147.91	$316.23
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 $66.07 / $93.33 / $213.80	Professional	TC	$66.07	$93.33	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $151.36 / $204.17	Professional		$123.03	$151.36	$204.17
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 $79.43 / $100.00 / $138.04	Professional	TC	$79.43	$100.00	$138.04