Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $44.67 / $56.23	Facility	26	$43.65	$44.67	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $288.40 / $630.96	Professional		$169.82	$288.40	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $52.48 / $107.15	Professional	26	$30.90	$52.48	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $245.47 / $389.05	Professional	TC	$151.36	$245.47	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $218.78 / $302.00	Professional		$199.53	$218.78	$302.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $41.69 / $47.86	Professional	26	$28.18	$41.69	$47.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $398.11 / $426.58	Professional		$346.74	$398.11	$426.58
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $60.26 / $60.26	Professional	26	$60.26	$60.26	$60.26
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $371.54 / $371.54	Professional	TC	$371.54	$371.54	$371.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $263.03 / $549.54	Professional		$45.71	$263.03	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $316.23 / $575.44	Professional		$245.47	$316.23	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $46.77 / $83.18	Professional	26	$30.90	$46.77	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $275.42 / $489.78	Professional	TC	$213.80	$275.42	$489.78
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $46.77 / $79.43	Facility	26	$38.90	$46.77	$79.43
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $302.00 / $489.78	Professional		$162.18	$302.00	$489.78
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $44.67 / $83.18	Professional	26	$28.84	$44.67	$83.18
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $257.04 / $389.05	Professional	TC	$131.83	$257.04	$389.05
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $316.23 / $562.34	Professional		$239.88	$316.23	$562.34
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $46.77 / $83.18	Professional	26	$28.18	$46.77	$83.18
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $275.42 / $489.78	Professional	TC	$154.88	$275.42	$489.78
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $263.03 / $371.54	Professional		$186.21	$263.03	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $42.66 / $58.88	Professional	26	$32.36	$42.66	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $223.87 / $323.59	Professional	TC	$151.36	$223.87	$323.59