Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $56.23 / $70.79	Facility	26	$56.23	$56.23	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $213.80 / $676.08	Professional		$134.90	$213.80	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $141.25	Professional	26	$42.66	$63.10	$141.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $125.89 / $323.59	Professional	TC	$95.50	$125.89	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $125.89 / $165.96	Professional		$114.82	$125.89	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $56.23 / $81.28	Professional	26	$37.15	$56.23	$81.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $102.33 / $154.88	Professional	TC	$79.43	$102.33	$154.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $234.42 / $251.19	Professional		$165.96	$234.42	$251.19
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $74.13 / $74.13	Professional	26	$74.13	$74.13	$74.13
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $177.83 / $177.83	Professional	TC	$177.83	$177.83	$177.83
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $128.82 / $223.87	Professional		$52.48	$128.82	$223.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $218.78 / $436.52	Professional		$134.90	$218.78	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $64.57 / $134.90	Professional	26	$38.90	$64.57	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $158.49 / $316.23	Professional	TC	$97.72	$158.49	$316.23
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $56.23 / $100.00	Facility	26	$56.23	$56.23	$100.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $186.21 / $467.74	Professional		$131.83	$186.21	$467.74
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $56.23 / $141.25	Professional	26	$40.74	$56.23	$141.25
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $125.89 / $269.15	Professional	TC	$95.50	$125.89	$269.15
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $177.83 / $380.19	Professional		$123.03	$177.83	$380.19
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $53.70 / $123.03	Professional	26	$36.31	$53.70	$123.03
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $128.82 / $309.03	Professional	TC	$89.13	$128.82	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $190.55 / $263.03	Professional		$147.91	$190.55	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $56.23 / $79.43	Professional	26	$44.67	$56.23	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $131.83 / $186.21	Professional	TC	$104.71	$131.83	$186.21