Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $91.20 / $114.82	Facility	26	$85.11	$91.20	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $478.63 / $1,380.38	Professional		$204.17	$478.63	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $131.83 / $363.08	Professional	26	$69.18	$131.83	$363.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $512.86 / $549.54 / $870.96	Professional	52	$512.86	$549.54	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $218.78 / $562.34	Professional	TC	$123.03	$218.78	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $154.88 / $288.40	Professional		$144.54	$154.88	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $112.20	Professional	26	$52.48	$66.07	$112.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $112.20 / $158.49	Professional	TC	$89.13	$112.20	$158.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $288.40 / $309.03	Professional		$186.21	$288.40	$309.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $151.36	Professional	26	$112.20	$112.20	$151.36
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	TC	$199.53	$199.53	$199.53
CareSource Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $147.91 / $251.19	Professional		$77.62	$147.91	$251.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $407.38 / $812.83	Professional		$190.55	$407.38	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $97.72 / $204.17	Professional	26	$58.88	$97.72	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $263.03 / $588.84	Professional	TC	$125.89	$263.03	$588.84
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $91.20 / $165.96	Facility	26	$85.11	$91.20	$165.96
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $389.05 / $891.25	Professional		$218.78	$389.05	$891.25
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $117.49 / $371.54	Professional	26	$69.18	$117.49	$371.54
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $524.81 / $870.96	Professional	52	$199.53	$524.81	$870.96
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $257.04 / $501.19	Professional	TC	$134.90	$257.04	$501.19
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $363.08 / $812.83	Professional		$165.96	$363.08	$812.83
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $83.18 / $169.82	Professional	26	$53.70	$83.18	$169.82
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $229.09 / $588.84	Professional	TC	$107.15	$229.09	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $269.15 / $575.44	Professional		$199.53	$269.15	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $81.28 / $123.03	Professional	26	$66.07	$81.28	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $173.78 / $467.74	Professional	TC	$128.82	$173.78	$467.74