Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $151.36 / $154.88 / $190.55	Facility	26	$151.36	$154.88	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $281.84 / $758.58	Professional		$199.53	$281.84	$758.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $151.36 / $446.68	Professional	26	$120.23	$151.36	$446.68
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	50	$616.60	$616.60	$616.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $93.33 / $158.49	Professional	TC	$75.86	$93.33	$158.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $208.93 / $288.40	Professional		$186.21	$208.93	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $128.82 / $169.82	Professional	26	$117.49	$128.82	$169.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $309.03 / $331.13	Professional		$190.55	$309.03	$331.13
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $204.17 / $257.04	Professional	26	$204.17	$204.17	$257.04
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	TC	$125.89	$125.89	$125.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $154.88 / $263.03	Professional		$77.62	$154.88	$263.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $147.91 / $208.93	Facility	26	$31.62	$147.91	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $309.03 / $851.14	Professional		$186.21	$309.03	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $181.97 / $524.81	Professional	26	$112.20	$181.97	$524.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $120.23 / $331.13	Professional	TC	$75.86	$120.23	$331.13
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $158.49 / $371.54	Facility	26	$138.04	$158.49	$371.54
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $549.54	Professional		$208.93	$257.04	$549.54
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $154.88 / $302.00	Professional	26	$123.03	$154.88	$302.00
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	50	$616.60	$616.60	$616.60
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $97.72 / $169.82	Professional	TC	$79.43	$97.72	$169.82
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $147.91 / $208.93	Facility	26	$31.62	$147.91	$208.93
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $851.14	Professional		$181.97	$302.00	$851.14
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $177.83 / $524.81	Professional	26	$107.15	$177.83	$524.81
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $117.49 / $331.13	Professional	TC	$70.79	$117.49	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $371.54	Professional		$208.93	$257.04	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $151.36 / $218.78	Professional	26	$123.03	$151.36	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $107.15 / $151.36	Professional	TC	$87.10	$107.15	$151.36