Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $51.29 / $64.57	Facility	26	$50.12	$51.29	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $102.33 / $489.78	Professional		$51.29	$102.33	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $51.29 / $123.03	Professional	26	$24.55	$51.29	$123.03
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $138.04 / $213.80 / $213.80	Professional	50	$138.04	$213.80	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $28.18 / $114.82	Professional	TC	$10.00	$28.18	$114.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $44.67 / $100.00	Professional		$39.81	$44.67	$100.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $39.81 / $57.54	Professional	26	$36.31	$39.81	$57.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $85.11 / $158.49	Professional		$79.43	$85.11	$158.49
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $67.61 / $85.11	Professional	26	$67.61	$67.61	$85.11
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $169.82 / $169.82 / $169.82	Professional	50	$169.82	$169.82	$169.82
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $16.98 / $16.98	Professional	TC	$14.45	$16.98	$16.98
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $50.12 / $77.62	Professional		$10.72	$50.12	$77.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $69.18	Facility	26	$10.47	$48.98	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $109.65 / $208.93	Professional		$46.77	$109.65	$208.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $42.66 / $117.49	Professional	26	$27.54	$42.66	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $45.71 / $144.54	Professional	TC	$10.00	$45.71	$144.54
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $51.29 / $70.79	Facility	26	$32.36	$51.29	$70.79
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $97.72 / $229.09	Professional		$54.95	$97.72	$229.09
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $47.86 / $100.00	Professional	26	$24.55	$47.86	$100.00
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $138.04 / $138.04 / $213.80	Professional	50	$138.04	$138.04	$213.80
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $35.48 / $114.82	Professional	TC	$12.02	$35.48	$114.82
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $69.18	Facility	26	$10.47	$48.98	$69.18
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $104.71 / $190.55	Professional		$45.71	$104.71	$190.55
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $36.31 / $75.86	Professional	26	$23.44	$36.31	$75.86
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $9.55 / $54.95 / $112.20	Professional	TC	$9.55	$54.95	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $114.82 / $158.49	Professional		$64.57	$114.82	$158.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $35.48 / $51.29	Professional	26	$28.18	$35.48	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $81.28 / $112.20	Professional	TC	$30.20	$81.28	$112.20