Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $100.00	Facility	26	$79.43	$79.43	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $117.49 / $281.84	Professional		$89.13	$117.49	$281.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $70.79 / $177.83	Professional	26	$56.23	$70.79	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $47.86 / $79.43	Professional	TC	$30.20	$47.86	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $123.03 / $239.88	Professional		$91.20	$123.03	$239.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $75.86 / $117.49	Professional	26	$52.48	$75.86	$117.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $154.88 / $165.96	Professional		$89.13	$154.88	$165.96
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $95.50 / $95.50	Professional	26	$81.28	$95.50	$95.50
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $70.79 / $70.79	Professional	TC	$70.79	$70.79	$70.79
CareSource Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $72.44 / $134.90	Professional		$41.69	$72.44	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $131.83 / $371.54	Professional		$97.72	$131.83	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $208.93	Professional	26	$60.26	$83.18	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $44.67 / $165.96	Professional	TC	$28.18	$44.67	$165.96
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $81.28 / $177.83	Facility	26	$66.07	$81.28	$177.83
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $123.03 / $208.93	Professional		$87.10	$123.03	$208.93
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.43 / $141.25	Professional	26	$57.54	$79.43	$141.25
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $47.86 / $75.86	Professional	TC	$27.54	$47.86	$75.86
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $131.83 / $371.54	Professional		$97.72	$131.83	$371.54
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $85.11 / $208.93	Professional	26	$60.26	$85.11	$208.93
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $45.71 / $165.96	Professional	TC	$32.36	$45.71	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $107.15 / $147.91	Professional		$89.13	$107.15	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $72.44 / $100.00	Professional	26	$60.26	$72.44	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $34.67 / $50.12	Professional	TC	$26.92	$34.67	$50.12