Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $218.78 / $281.84	Facility	26	$213.80	$218.78	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $331.13 / $870.96	Professional		$269.15	$331.13	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $213.80 / $588.84	Professional	26	$169.82	$213.80	$588.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $186.21	Professional	TC	$93.33	$114.82	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $281.84 / $398.11	Professional		$263.03	$281.84	$398.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $165.96 / $346.74	Professional	26	$165.96	$165.96	$346.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $426.58 / $457.09	Professional		$257.04	$426.58	$457.09
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	26	$295.12	$295.12	$295.12
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	TC	$162.18	$162.18	$162.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $218.78 / $363.08	Professional		$97.72	$218.78	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $208.93 / $295.12	Facility	26	$44.67	$208.93	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $407.38 / $1,148.15	Professional		$251.19	$407.38	$1,148.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $257.04 / $741.31	Professional	26	$158.49	$257.04	$741.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $151.36 / $416.87	Professional	TC	$95.50	$151.36	$416.87
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $269.15 / $537.03	Facility	26	$194.98	$269.15	$537.03
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $338.84 / $645.65	Professional		$281.84	$338.84	$645.65
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $213.80 / $407.38	Professional	26	$173.78	$213.80	$407.38
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $123.03 / $199.53	Professional	TC	$100.00	$123.03	$199.53
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $208.93 / $295.12	Facility	26	$44.67	$208.93	$295.12
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $398.11 / $1,148.15	Professional		$234.42	$398.11	$1,148.15
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $251.19 / $741.31	Professional	26	$151.36	$251.19	$741.31
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $144.54 / $416.87	Professional	TC	$91.20	$144.54	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $346.74 / $478.63	Professional		$281.84	$346.74	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $213.80 / $309.03	Professional	26	$173.78	$213.80	$309.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $131.83 / $173.78	Professional	TC	$104.71	$131.83	$173.78