Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $309.03 / $741.31	Facility		$61.66	$309.03	$741.31
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.90 / $77.62 / $141.25	Facility	TC	$38.90	$77.62	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $85.11 / $537.03	Professional		$53.70	$85.11	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $95.50 / $831.76	Professional	26	$33.88	$95.50	$831.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $61.66 / $549.54	Professional	TC	$26.92	$61.66	$549.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $33.11 / $69.18	Professional		$33.11	$33.11	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $40.74 / $47.86	Professional	26	$16.98	$40.74	$47.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $15.85 / $15.85	Professional	TC	$15.85	$15.85	$15.85
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $104.71 / $131.83	Professional		$51.29	$104.71	$131.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $54.95 / $74.13	Professional	26	$54.95	$54.95	$74.13
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $67.61	Professional	TC	$50.12	$50.12	$67.61
CareSource Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $66.07 / $173.78	Facility		$31.62	$66.07	$173.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $52.48 / $91.20	Professional		$34.67	$52.48	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $97.72 / $251.19	Professional		$33.88	$97.72	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $48.98 / $138.04	Professional	26	$18.62	$48.98	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $41.69 / $75.86	Professional	TC	$14.79	$41.69	$75.86
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $309.03 / $933.25	Facility		$69.18	$309.03	$933.25
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $38.90 / $56.23 / $141.25	Facility	TC	$38.90	$56.23	$141.25
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $93.33 / $478.63	Professional		$60.26	$93.33	$478.63
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $77.62 / $851.14	Professional	26	$33.88	$77.62	$851.14
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $45.71 / $151.36	Professional	TC	$28.84	$45.71	$151.36
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $52.48 / $141.25	Professional		$30.90	$52.48	$141.25
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $19.05 / $69.18	Professional	26	$15.49	$19.05	$69.18
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $16.98 / $48.98	Professional	TC	$14.79	$16.98	$48.98
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $70.79 / $109.65	Professional		$42.66	$70.79	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $37.15 / $54.95	Professional	26	$23.44	$37.15	$54.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $39.81 / $64.57	Professional	TC	$19.05	$39.81	$64.57