Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $501.19 / $616.60	Facility	26	$489.78	$501.19	$616.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $2,089.30 / $4,677.35	Professional		$1,584.89	$2,089.30	$4,677.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $501.19 / $1,202.26	Professional	26	$346.74	$501.19	$1,202.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,174.90 / $1,584.89 / $2,818.38	Professional	TC	$1,174.90	$1,584.89	$2,818.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,778.28 / $2,754.23	Professional		$1,380.38	$1,778.28	$2,754.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $416.87 / $616.60	Professional	26	$331.13	$416.87	$616.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $2,818.38 / $3,019.95	Professional		$602.56	$2,818.38	$3,019.95
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $630.96 / $630.96 / $630.96	Professional	26	$630.96	$630.96	$630.96
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Professional	TC	$2,398.83	$2,398.83	$2,398.83
CareSource Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $1,659.59 / $3,801.89	Professional		$512.86	$1,659.59	$3,801.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $2,344.23 / $4,365.16	Professional		$1,698.24	$2,344.23	$4,365.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $354.81 / $489.78 / $933.25	Professional	26	$354.81	$489.78	$933.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,318.26 / $1,862.09 / $3,548.13	Professional	TC	$1,318.26	$1,862.09	$3,548.13
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $512.86 / $912.01	Facility	26	$489.78	$512.86	$912.01
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $2,137.96 / $3,467.37	Professional		$1,548.82	$2,137.96	$3,467.37
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $489.78 / $954.99	Professional	26	$331.13	$489.78	$954.99
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $1,230.27 / $1,698.24 / $2,818.38	Professional	TC	$1,230.27	$1,698.24	$2,818.38
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $2,238.72 / $4,265.80	Professional		$1,659.59	$2,238.72	$4,265.80
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $323.59 / $489.78 / $933.25	Professional	26	$323.59	$489.78	$933.25
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,258.93 / $1,737.80 / $3,548.13	Professional	TC	$1,258.93	$1,737.80	$3,548.13
United Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $2,238.72 / $3,090.30	Professional		$1,659.59	$2,238.72	$3,090.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $363.08 / $478.63 / $676.08	Professional	26	$363.08	$478.63	$676.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,288.25 / $1,778.28 / $2,398.83	Professional	TC	$1,288.25	$1,778.28	$2,398.83