Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $218.78 / $338.84	Facility		$213.80	$218.78	$338.84
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $97.72 / $97.72 / $107.15	Facility	TC	$97.72	$97.72	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $102.33 / $426.58	Professional		$64.57	$102.33	$426.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $70.79 / $354.81	Professional	26	$26.92	$70.79	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $64.57 / $173.78	Professional	TC	$43.65	$64.57	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $51.29 / $107.15	Professional		$51.29	$51.29	$107.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $38.02 / $44.67	Professional	26	$16.60	$38.02	$44.67
BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $177.83 / $177.83	Professional		$131.83	$177.83	$177.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $53.70 / $72.44	Professional	26	$53.70	$53.70	$72.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $125.89 / $169.82	Professional	TC	$125.89	$125.89	$169.82
CareSource Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $102.33 / $269.15	Facility		$31.62	$102.33	$269.15
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $87.10 / $158.49	Professional		$36.31	$87.10	$158.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $125.89	Facility		$53.70	$53.70	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $97.72 / $354.81	Professional		$47.86	$97.72	$354.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $45.71 / $120.23	Professional	26	$17.78	$45.71	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $33.88 / $154.88	Professional	TC	$21.88	$33.88	$154.88
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $288.40 / $338.84	Facility		$144.54	$288.40	$338.84
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $97.72 / $97.72 / $107.15	Facility	TC	$97.72	$97.72	$107.15
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $120.23 / $338.84	Professional		$75.86	$120.23	$338.84
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $48.98 / $309.03	Professional	26	$28.84	$48.98	$309.03
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $75.86 / $154.88	Professional	TC	$52.48	$75.86	$154.88
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $125.89	Facility		$53.70	$53.70	$125.89
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $51.29 / $151.36	Professional		$46.77	$51.29	$151.36
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $20.42 / $56.23	Professional	26	$14.45	$20.42	$56.23
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $32.36 / $107.15	Professional	TC	$13.80	$32.36	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $97.72 / $151.36	Professional		$61.66	$97.72	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $37.15 / $51.29	Professional	26	$21.88	$37.15	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $58.88 / $97.72	Professional	TC	$36.31	$58.88	$97.72