Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $83.18 / $1,949.84	Facility	26	$79.43	$83.18	$1,949.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $371.54 / $1,380.38	Professional		$114.82	$371.54	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $123.03 / $354.81	Professional	26	$64.57	$123.03	$354.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $660.69 / $1,230.27 / $1,905.46	Professional	50	$660.69	$1,230.27	$1,905.46
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $407.38 / $512.86 / $524.81	Professional	52	$407.38	$512.86	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $263.03 / $588.84	Professional	TC	$144.54	$263.03	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $186.21 / $288.40	Professional		$154.88	$186.21	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $123.03	Professional	26	$51.29	$75.86	$123.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $125.89 / $165.96	Professional	TC	$102.33	$125.89	$165.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $512.86 / $616.60	Professional		$239.88	$512.86	$616.60
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $102.33 / $138.04	Professional	26	$102.33	$102.33	$138.04
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $660.69 / $660.69 / $891.25	Professional	50	$660.69	$660.69	$891.25
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $229.09 / $229.09	Professional	TC	$229.09	$229.09	$229.09
CareSource Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $165.96 / $288.40	Professional		$70.79	$165.96	$288.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $426.58 / $776.25	Professional		$204.17	$426.58	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $190.55	Professional	26	$53.70	$85.11	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $295.12 / $524.81	Professional	TC	$141.25	$295.12	$524.81
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $83.18 / $158.49	Facility	26	$79.43	$83.18	$158.49
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $398.11 / $1,023.29	Professional		$199.53	$398.11	$1,023.29
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $107.15 / $275.42	Professional	26	$63.10	$107.15	$275.42
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $660.69 / $1,230.27 / $1,230.27	Professional	50	$660.69	$1,230.27	$1,230.27
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $407.38 / $512.86 / $524.81	Professional	52	$407.38	$512.86	$524.81
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $281.84 / $537.03	Professional	TC	$158.49	$281.84	$537.03
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $363.08 / $741.31	Professional		$177.83	$363.08	$741.31
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $144.54	Professional	26	$50.12	$70.79	$144.54
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $263.03 / $524.81	Professional	TC	$120.23	$263.03	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $281.84 / $575.44	Professional		$208.93	$281.84	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $72.44 / $112.20	Professional	26	$61.66	$72.44	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $194.98 / $467.74	Professional	TC	$147.91	$194.98	$467.74