Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $56.23 / $69.18	Facility	26	$54.95	$56.23	$69.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $93.33 / $223.87	Professional		$66.07	$93.33	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $54.95 / $144.54	Professional	26	$38.02	$54.95	$144.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $40.74 / $67.61	Professional	TC	$22.91	$40.74	$67.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $72.44 / $181.97	Professional		$61.66	$72.44	$181.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $43.65 / $58.88	Professional	26	$35.48	$43.65	$58.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $44.67	Professional	TC	$44.67	$44.67	$44.67
BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $117.49 / $125.89	Professional		$60.26	$117.49	$125.89
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $64.57 / $64.57	Professional	26	$64.57	$64.57	$64.57
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $60.26 / $60.26	Professional	TC	$60.26	$60.26	$60.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $48.98 / $91.20	Professional		$35.48	$48.98	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $95.50 / $281.84	Professional		$72.44	$95.50	$281.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $56.23 / $144.54	Professional	26	$40.74	$56.23	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $141.25	Professional	TC	$23.99	$36.31	$141.25
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $56.23 / $120.23	Facility	26	$44.67	$56.23	$120.23
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $93.33 / $154.88	Professional		$63.10	$93.33	$154.88
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $53.70 / $100.00	Professional	26	$39.81	$53.70	$100.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $39.81 / $64.57	Professional	TC	$20.89	$39.81	$64.57
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $95.50 / $281.84	Professional		$74.13	$95.50	$281.84
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $57.54 / $144.54	Professional	26	$40.74	$57.54	$144.54
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $38.02 / $141.25	Professional	TC	$26.92	$38.02	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $75.86 / $104.71	Professional		$63.10	$75.86	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $50.12 / $67.61	Professional	26	$41.69	$50.12	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $27.54 / $43.65	Professional	TC	$20.89	$27.54	$43.65