Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Facility	26	$93.33	$93.33	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $165.96 / $363.08	Professional		$131.83	$165.96	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $83.18 / $199.53	Professional	26	$72.44	$83.18	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $81.28 / $128.82	Professional	TC	$56.23	$81.28	$128.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Professional	26	$104.71	$104.71	$104.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $229.09 / $245.47	Professional		$117.49	$229.09	$245.47
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	26	$125.89	$125.89	$125.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $95.50 / $190.55	Professional		$74.13	$95.50	$190.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $89.13 / $128.82	Facility	26	$19.50	$89.13	$128.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $223.87 / $630.96	Professional		$125.89	$223.87	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $323.59	Professional	26	$69.18	$112.20	$323.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $112.20 / $316.23	Professional	TC	$53.70	$112.20	$316.23
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $190.55 / $223.87	Facility	26	$77.62	$190.55	$223.87
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $177.83 / $281.84	Professional		$134.90	$177.83	$281.84
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $89.13 / $147.91	Professional	26	$75.86	$89.13	$147.91
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $83.18 / $131.83	Professional	TC	$58.88	$83.18	$131.83
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $89.13 / $128.82	Facility	26	$19.50	$89.13	$128.82
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $218.78 / $630.96	Professional		$114.82	$218.78	$630.96
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $109.65 / $323.59	Professional	26	$64.57	$109.65	$323.59
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $109.65 / $316.23	Professional	TC	$51.29	$109.65	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $257.04	Professional		$123.03	$169.82	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $93.33 / $134.90	Professional	26	$75.86	$93.33	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $85.11 / $123.03	Professional	TC	$38.90	$85.11	$123.03