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 $34.67 / $75.86 / $229.09	Professional		$34.67	$75.86	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $53.70 / $141.25	Professional	26	$19.95	$53.70	$141.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $36.31 / $70.79 / $263.03	Professional	50	$36.31	$70.79	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $8.91 / $28.18 / $87.10	Professional	TC	$8.91	$28.18	$87.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $51.29 / $75.86	Professional		$44.67	$51.29	$75.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $30.90 / $52.48	Professional	26	$25.12	$30.90	$52.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $38.02 / $38.02	Professional	TC	$38.02	$38.02	$38.02
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $102.33 / $190.55	Professional		$58.88	$102.33	$190.55
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	26	$52.48	$52.48	$52.48
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $204.17 / $204.17 / $275.42	Professional	50	$204.17	$204.17	$275.42
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	TC	$50.12	$50.12	$50.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $42.66 / $81.28	Professional		$30.90	$42.66	$81.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $53.70	Facility	26	$7.94	$37.15	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $58.88 / $169.82	Professional		$32.36	$58.88	$169.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $33.11 / $89.13	Professional	26	$21.38	$33.11	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $26.92 / $85.11	Professional	TC	$9.77	$26.92	$85.11
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $51.29	Facility	26	$38.90	$38.90	$51.29
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $67.61 / $177.83	Professional		$30.90	$67.61	$177.83
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $38.90 / $107.15	Professional	26	$19.50	$38.90	$107.15
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $36.31 / $70.79 / $263.03	Professional	50	$36.31	$70.79	$263.03
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $9.12 / $23.99 / $61.66	Professional	TC	$9.12	$23.99	$61.66
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $53.70	Facility	26	$7.94	$37.15	$53.70
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $52.48 / $117.49	Professional		$29.51	$52.48	$117.49
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $27.54 / $57.54	Professional	26	$18.62	$27.54	$57.54
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $9.55 / $25.70 / $60.26	Professional	TC	$9.55	$25.70	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $44.67 / $75.86	Professional		$32.36	$44.67	$75.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $25.70 / $38.90	Professional	26	$21.38	$25.70	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $14.79 / $39.81	Professional	TC	$10.47	$14.79	$39.81