Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $70.79 / $89.13	Facility	26	$70.79	$70.79	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $177.83 / $691.83	Professional		$114.82	$177.83	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $186.21 / $870.96	Professional	26	$57.54	$186.21	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $75.86 / $158.49	Professional	TC	$52.48	$75.86	$158.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $120.23 / $190.55	Professional		$95.50	$120.23	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $85.11	Professional	26	$47.86	$58.88	$85.11
BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $218.78 / $234.42	Professional		$208.93	$218.78	$234.42
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Professional	26	$100.00	$100.00	$100.00
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $138.04 / $138.04	Professional	TC	$138.04	$138.04	$138.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $131.83 / $269.15	Professional		$72.44	$131.83	$269.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $173.78 / $323.59	Professional		$112.20	$173.78	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $75.86 / $134.90	Professional	26	$52.48	$75.86	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $97.72 / $190.55	Professional	TC	$60.26	$97.72	$190.55
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $72.44 / $141.25	Facility	26	$67.61	$72.44	$141.25
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $151.36 / $281.84	Professional		$117.49	$151.36	$281.84
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $77.62 / $575.44	Professional	26	$53.70	$77.62	$575.44
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $81.28 / $147.91	Professional	TC	$61.66	$81.28	$147.91
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $154.88 / $323.59	Professional		$112.20	$154.88	$323.59
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $134.90	Professional	26	$50.12	$75.86	$134.90
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $89.13 / $199.53	Professional	TC	$57.54	$89.13	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $162.18 / $223.87	Professional		$125.89	$162.18	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $70.79 / $97.72	Professional	26	$56.23	$70.79	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $91.20 / $144.54	Professional	TC	$67.61	$91.20	$144.54