Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $48.98	Facility	26	$38.90	$38.90	$48.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $165.96 / $630.96	Professional		$89.13	$165.96	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $53.70 / $151.36	Professional	26	$28.84	$53.70	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $93.33 / $275.42	Professional	TC	$61.66	$93.33	$275.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $91.20 / $165.96	Professional		$72.44	$91.20	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.90 / $61.66	Professional	26	$24.55	$30.90	$61.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $52.48 / $128.82	Professional	TC	$43.65	$52.48	$128.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $154.88 / $165.96	Professional		$107.15	$154.88	$165.96
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Professional	26	$51.29	$51.29	$51.29
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $114.82 / $114.82	Professional	TC	$114.82	$114.82	$114.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $79.43 / $144.54	Professional		$36.31	$79.43	$144.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $131.83 / $302.00	Professional		$85.11	$131.83	$302.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $39.81 / $95.50	Professional	26	$26.30	$39.81	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $89.13 / $208.93	Professional	TC	$57.54	$89.13	$208.93
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $69.18	Facility	26	$38.90	$38.90	$69.18
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $138.04 / $323.59	Professional		$97.72	$138.04	$323.59
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $42.66 / $114.82	Professional	26	$28.84	$42.66	$114.82
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $91.20 / $169.82	Professional	TC	$66.07	$91.20	$169.82
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $112.20 / $245.47	Professional		$83.18	$112.20	$245.47
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $35.48 / $70.79	Professional	26	$23.44	$35.48	$70.79
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $75.86 / $177.83	Professional	TC	$56.23	$75.86	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $123.03 / $169.82	Professional		$95.50	$123.03	$169.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $37.15 / $51.29	Professional	26	$29.51	$37.15	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $85.11 / $117.49	Professional	TC	$64.57	$85.11	$117.49