Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $109.65 / $114.82	Facility	26	$107.15	$109.65	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $371.54 / $1,148.15	Professional		$234.42	$371.54	$1,148.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $131.83 / $398.11	Professional	26	$79.43	$131.83	$398.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $181.97 / $346.74	Professional	TC	$138.04	$181.97	$346.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $457.09	Professional		$208.93	$257.04	$457.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $95.50 / $158.49	Professional	26	$79.43	$95.50	$158.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $338.84 / $363.08	Professional		$269.15	$338.84	$363.08
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $128.82 / $162.18	Professional	26	$109.65	$128.82	$162.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $239.88 / $239.88	Professional	TC	$239.88	$239.88	$239.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $177.83 / $302.00	Professional		$89.13	$177.83	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $331.13 / $724.44	Professional		$218.78	$331.13	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $117.49 / $251.19	Professional	26	$83.18	$117.49	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $208.93 / $478.63	Professional	TC	$154.88	$208.93	$478.63
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $109.65 / $229.09	Facility	26	$107.15	$109.65	$229.09
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $302.00 / $851.14	Professional		$234.42	$302.00	$851.14
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $109.65 / $309.03	Professional	26	$79.43	$109.65	$309.03
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $186.21 / $302.00	Professional	TC	$147.91	$186.21	$302.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $512.86	Professional		$181.97	$302.00	$512.86
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $112.20 / $181.97	Professional	26	$81.28	$112.20	$181.97
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $190.55 / $338.84	Professional	TC	$144.54	$190.55	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $295.12 / $416.87	Professional		$223.87	$295.12	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $104.71 / $151.36	Professional	26	$83.18	$104.71	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $186.21 / $257.04	Professional	TC	$144.54	$186.21	$257.04