Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $83.18 / $104.71	Facility	26	$77.62	$83.18	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $446.68 / $1,445.44	Professional		$162.18	$446.68	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $134.90 / $398.11	Professional	26	$64.57	$134.90	$398.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $707.95 / $724.44 / $1,096.48	Professional	50	$707.95	$724.44	$1,096.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $302.00 / $616.60	Professional	TC	$177.83	$302.00	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $177.83 / $218.78	Professional		$169.82	$177.83	$218.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $61.66 / $104.71	Professional	26	$51.29	$61.66	$104.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $173.78 / $190.55	Professional	TC	$123.03	$173.78	$190.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $363.08 / $676.08	Professional		$323.59	$363.08	$676.08
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $102.33 / $138.04	Professional	26	$102.33	$102.33	$138.04
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $724.44 / $724.44 / $977.24	Professional	50	$724.44	$724.44	$977.24
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $257.04 / $257.04	Professional	TC	$257.04	$257.04	$257.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $186.21 / $316.23	Professional		$70.79	$186.21	$316.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $457.09 / $870.96	Professional		$229.09	$457.09	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $186.21	Professional	26	$53.70	$85.11	$186.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $323.59 / $707.95	Professional	TC	$165.96	$323.59	$707.95
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $83.18 / $141.25	Facility	26	$77.62	$83.18	$141.25
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $426.58 / $977.24	Professional		$234.42	$426.58	$977.24
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $109.65 / $309.03	Professional	26	$61.66	$109.65	$309.03
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $707.95 / $724.44 / $1,096.48	Professional	50	$707.95	$724.44	$1,096.48
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $316.23 / $575.44	Professional	TC	$186.21	$316.23	$575.44
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $398.11 / $891.25	Professional		$194.98	$398.11	$891.25
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $70.79 / $141.25	Professional	26	$48.98	$70.79	$141.25
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $295.12 / $676.08	Professional	TC	$141.25	$295.12	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $380.19 / $588.84	Professional		$239.88	$380.19	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $112.20	Professional	26	$60.26	$70.79	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $288.40 / $489.78	Professional	TC	$173.78	$288.40	$489.78