Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $602.56 / $645.65	Facility		$61.66	$602.56	$645.65
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $35.48 / $66.07	Facility	TC	$31.62	$35.48	$66.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $64.57 / $169.82	Professional		$50.12	$64.57	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $34.67 / $223.87	Professional	26	$18.20	$34.67	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $38.02 / $95.50	Professional	TC	$26.92	$38.02	$95.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $66.07 / $66.07	Professional		$66.07	$66.07	$66.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $26.30 / $33.88	Professional	26	$12.59	$26.30	$33.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $107.15 / $107.15	Professional		$61.66	$107.15	$107.15
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $57.54	Professional	26	$42.66	$42.66	$57.54
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $48.98 / $48.98	Professional	TC	$48.98	$48.98	$48.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $61.66 / $162.18	Facility		$25.12	$61.66	$162.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $56.23 / $95.50	Professional		$28.84	$56.23	$95.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $158.49	Facility		$141.25	$141.25	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $91.20 / $263.03	Professional		$30.20	$91.20	$263.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $40.74 / $114.82	Professional	26	$13.80	$40.74	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $42.66 / $89.13	Professional	TC	$17.38	$42.66	$89.13
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $602.56 / $645.65	Facility		$61.66	$602.56	$645.65
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $35.48 / $66.07	Facility	TC	$31.62	$35.48	$66.07
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $83.18 / $169.82	Professional		$53.70	$83.18	$169.82
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $41.69 / $181.97	Professional	26	$22.91	$41.69	$181.97
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $44.67 / $83.18	Professional	TC	$30.90	$44.67	$83.18
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $158.49	Facility		$141.25	$141.25	$158.49
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $32.36 / $194.98	Professional		$28.84	$32.36	$194.98
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.13 / $120.23	Professional	26	$11.48	$14.13	$120.23
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $19.50 / $58.88	Professional	TC	$16.22	$19.50	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $69.18 / $117.49	Professional		$40.74	$69.18	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $35.48 / $57.54	Professional	26	$17.38	$35.48	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $39.81 / $54.95	Professional	TC	$23.99	$39.81	$54.95