Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $20.89 / $26.30	Facility	26	$19.95	$20.89	$26.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $75.86 / $407.38	Professional		$54.95	$75.86	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $26.30 / $120.23	Professional	26	$16.60	$26.30	$120.23
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $54.95 / $199.53	Professional	50	$28.84	$54.95	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $45.71 / $74.13	Professional	TC	$38.02	$45.71	$74.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $67.61 / $89.13	Professional		$56.23	$67.61	$89.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $18.20 / $32.36	Professional	26	$17.78	$18.20	$32.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $95.50 / $177.83	Professional		$69.18	$95.50	$177.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $28.84 / $38.90	Professional	26	$28.84	$28.84	$38.90
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	50	$190.55	$190.55	$190.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $45.71 / $74.13	Professional		$19.05	$45.71	$74.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.37 / $20.42 / $29.51	Facility	26	$4.37	$20.42	$29.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $87.10 / $245.47	Professional		$53.70	$87.10	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $25.12 / $72.44	Professional	26	$15.85	$25.12	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $60.26 / $173.78	Professional	TC	$37.15	$60.26	$173.78
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $26.30 / $50.12	Facility	26	$17.38	$26.30	$50.12
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $72.44 / $190.55	Professional		$54.95	$72.44	$190.55
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $21.88 / $60.26	Professional	26	$16.98	$21.88	$60.26
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $48.98 / $199.53	Professional	50	$28.84	$48.98	$199.53
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $48.98 / $81.28	Professional	TC	$38.02	$48.98	$81.28
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $4.37 / $20.42 / $29.51	Facility	26	$4.37	$20.42	$29.51
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $81.28 / $245.47	Professional		$47.86	$81.28	$245.47
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $25.12 / $72.44	Professional	26	$14.45	$25.12	$72.44
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $54.95 / $173.78	Professional	TC	$33.11	$54.95	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $66.07 / $91.20	Professional		$54.95	$66.07	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $20.89 / $30.90	Professional	26	$17.38	$20.89	$30.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $44.67 / $61.66	Professional	TC	$38.02	$44.67	$61.66