Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $114.82	Facility	26	$91.20	$91.20	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $501.19 / $1,230.27	Professional		$338.84	$501.19	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $138.04 / $354.81	Professional	26	$72.44	$138.04	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $363.08 / $870.96	Professional	TC	$263.03	$363.08	$870.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $257.04 / $257.04	Professional		$257.04	$257.04	$257.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $93.33 / $147.91	Professional	26	$58.88	$93.33	$147.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $501.19 / $537.03	Professional		$398.11	$501.19	$537.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	26	$109.65	$109.65	$109.65
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $426.58 / $426.58	Professional	TC	$426.58	$426.58	$426.58
CareSource Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $288.40 / $407.38	Professional		$70.79	$288.40	$407.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $707.95 / $1,479.11	Professional		$338.84	$707.95	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $100.00 / $208.93	Professional	26	$58.88	$100.00	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $524.81 / $1,230.27	Professional	TC	$269.15	$524.81	$1,230.27
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $93.33 / $204.17	Facility	26	$89.13	$93.33	$204.17
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $575.44 / $1,148.15	Professional		$363.08	$575.44	$1,148.15
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $117.49 / $316.23	Professional	26	$70.79	$117.49	$316.23
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $426.58 / $870.96	Professional	TC	$269.15	$426.58	$870.96
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $616.60 / $1,479.11	Professional		$288.40	$616.60	$1,479.11
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $93.33 / $190.55	Professional	26	$58.88	$93.33	$190.55
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $478.63 / $1,288.25	Professional	TC	$223.87	$478.63	$1,288.25
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $602.56 / $1,047.13	Professional		$338.84	$602.56	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $91.20 / $128.82	Professional	26	$69.18	$91.20	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $489.78 / $912.01	Professional	TC	$269.15	$489.78	$912.01