Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $131.83 / $165.96	Facility	26	$125.89	$131.83	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $562.34 / $2,238.72	Professional		$354.81	$562.34	$2,238.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $186.21 / $524.81	Professional	26	$102.33	$186.21	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $346.74 / $891.25	Professional	TC	$251.19	$346.74	$891.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $275.42 / $316.23	Professional		$251.19	$275.42	$316.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $134.90 / $181.97	Professional	26	$95.50	$134.90	$181.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $512.86 / $549.54	Professional		$457.09	$512.86	$549.54
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	26	$162.18	$162.18	$162.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $389.05 / $389.05	Professional	TC	$389.05	$389.05	$389.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $281.84 / $478.63	Professional		$112.20	$281.84	$478.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $645.65 / $1,230.27	Professional		$346.74	$645.65	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $134.90 / $295.12	Professional	26	$85.11	$134.90	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $478.63 / $1,047.13	Professional	TC	$245.47	$478.63	$1,047.13
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $131.83 / $223.87	Facility	26	$125.89	$131.83	$223.87
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $549.54 / $1,258.93	Professional		$371.54	$549.54	$1,258.93
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $151.36 / $478.63	Professional	26	$97.72	$151.36	$478.63
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $407.38 / $794.33	Professional	TC	$263.03	$407.38	$794.33
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $575.44 / $1,230.27	Professional		$295.12	$575.44	$1,230.27
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $112.20 / $223.87	Professional	26	$75.86	$112.20	$223.87
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $407.38 / $1,047.13	Professional	TC	$208.93	$407.38	$1,047.13
United Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $501.19 / $1,071.52	Professional		$363.08	$501.19	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $112.20 / $177.83	Professional	26	$95.50	$112.20	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $371.54 / $891.25	Professional	TC	$257.04	$371.54	$891.25