Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $138.04	Facility	26	$109.65	$109.65	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $354.81 / $741.31	Professional		$245.47	$354.81	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $295.12	Professional	26	$77.62	$114.82	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $229.09 / $537.03	Professional	TC	$169.82	$229.09	$537.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $239.88	Professional		$239.88	$239.88	$239.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $181.97	Professional	26	$64.57	$75.86	$181.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $467.74 / $501.19	Professional		$354.81	$467.74	$501.19
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $181.97	Professional	26	$134.90	$134.90	$181.97
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $363.08 / $363.08	Professional	TC	$363.08	$363.08	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $141.25	Facility	26	$20.89	$97.72	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $489.78 / $1,000.00	Professional		$281.84	$489.78	$1,000.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $109.65 / $251.19	Professional	26	$72.44	$109.65	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $354.81 / $741.31	Professional	TC	$204.17	$354.81	$741.31
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $199.53	Facility	26	$109.65	$109.65	$199.53
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $389.05 / $724.44	Professional		$269.15	$389.05	$724.44
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $107.15 / $245.47	Professional	26	$77.62	$107.15	$245.47
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $309.03 / $512.86	Professional	TC	$186.21	$309.03	$512.86
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $141.25	Facility	26	$20.89	$97.72	$141.25
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $1,023.29	Professional		$263.03	$380.19	$1,023.29
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $91.20 / $199.53	Professional	26	$64.57	$91.20	$199.53
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $269.15 / $676.08	Professional	TC	$186.21	$269.15	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $398.11 / $645.65	Professional		$302.00	$398.11	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $151.36	Professional	26	$81.28	$100.00	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $281.84 / $501.19	Professional	TC	$213.80	$281.84	$501.19