Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $45.71 / $91.20	Facility		$45.71	$45.71	$91.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $66.07 / $117.49 / $117.49	Facility	TC	$66.07	$117.49	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $91.20 / $169.82	Professional		$74.13	$91.20	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $173.78 / $812.83	Professional	26	$52.48	$173.78	$812.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $36.31 / $69.18	Professional	TC	$28.18	$36.31	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $29.51 / $79.43	Professional	26	$28.18	$29.51	$79.43
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $151.36 / $162.18	Professional		$89.13	$151.36	$162.18
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $95.50 / $128.82	Professional	26	$95.50	$95.50	$128.82
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 $36.31 / $97.72 / $239.88	Facility		$36.31	$97.72	$239.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $81.28 / $141.25	Professional		$42.66	$81.28	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $87.10 / $389.05	Professional		$46.77	$87.10	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $81.28 / $229.09	Professional	26	$30.90	$81.28	$229.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $23.99 / $89.13	Professional	TC	$16.22	$23.99	$89.13
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $45.71 / $91.20	Facility		$45.71	$45.71	$91.20
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $66.07 / $66.07 / $117.49	Facility	TC	$66.07	$66.07	$117.49
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $112.20 / $194.98	Professional		$79.43	$112.20	$194.98
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $93.33 / $630.96	Professional	26	$54.95	$93.33	$630.96
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $43.65 / $69.18	Professional	TC	$30.90	$43.65	$69.18
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $58.88 / $134.90	Professional		$43.65	$58.88	$134.90
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $31.62 / $89.13	Professional	26	$26.30	$31.62	$89.13
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $19.05 / $54.95	Professional	TC	$16.22	$19.05	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $93.33 / $141.25	Professional		$56.23	$93.33	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $60.26 / $91.20	Professional	26	$38.02	$60.26	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $30.20 / $48.98	Professional	TC	$19.05	$30.20	$48.98