Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $20.42 / $25.70	Facility	26	$19.95	$20.42	$25.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $89.13 / $199.53	Professional		$57.54	$89.13	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $19.95 / $51.29	Professional	26	$14.13	$19.95	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $61.66 / $123.03	Professional	TC	$42.66	$61.66	$123.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $50.12 / $53.70	Professional		$48.98	$50.12	$53.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $14.79 / $16.60	Professional	26	$14.79	$14.79	$16.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $46.77 / $46.77	Professional	TC	$46.77	$46.77	$46.77
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $120.23 / $128.82	Professional		$89.13	$120.23	$128.82
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $26.92 / $26.92	Professional	26	$26.92	$26.92	$26.92
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $100.00 / $100.00	Professional	TC	$100.00	$100.00	$100.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.17 / $19.50 / $27.54	Facility	26	$4.17	$19.50	$27.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $97.72 / $218.78	Professional		$58.88	$97.72	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.44 / $48.98	Professional	26	$14.13	$23.44	$48.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $79.43 / $177.83	Professional	TC	$46.77	$79.43	$177.83
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $25.70 / $38.90	Facility	26	$19.95	$25.70	$38.90
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $85.11 / $169.82	Professional		$52.48	$85.11	$169.82
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $19.05 / $44.67	Professional	26	$13.49	$19.05	$44.67
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $63.10 / $123.03	Professional	TC	$38.02	$63.10	$123.03
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $4.17 / $19.50 / $27.54	Facility	26	$4.17	$19.50	$27.54
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $74.13 / $169.82	Professional		$53.70	$74.13	$169.82
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $19.50 / $44.67	Professional	26	$13.18	$19.50	$44.67
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $60.26 / $173.78	Professional	TC	$40.74	$60.26	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $75.86 / $117.49	Professional		$63.10	$75.86	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.50 / $30.20	Professional	26	$15.85	$19.50	$30.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $57.54 / $91.20	Professional	TC	$46.77	$57.54	$91.20