Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $42.66 / $56.23	Facility	26	$42.66	$42.66	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $194.98 / $549.54	Professional		$112.20	$194.98	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $53.70 / $144.54	Professional	26	$33.11	$53.70	$144.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.95 / $77.62 / $363.08	Professional	52	$19.95	$77.62	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $107.15 / $275.42	Professional	TC	$79.43	$107.15	$275.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $97.72 / $131.83	Professional		$87.10	$97.72	$131.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $33.88 / $53.70	Professional	26	$26.92	$33.88	$53.70
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.44 / $23.44 / $194.98	Professional	52	$23.44	$23.44	$194.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $87.10 / $125.89	Professional	TC	$66.07	$87.10	$125.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $190.55 / $204.17	Professional		$138.04	$190.55	$204.17
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $57.54	Professional	26	$57.54	$57.54	$57.54
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $147.91 / $147.91	Professional	TC	$147.91	$147.91	$147.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $107.15 / $177.83	Professional		$39.81	$107.15	$177.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $41.69 / $58.88	Facility	26	$8.91	$41.69	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $173.78 / $346.74	Professional		$109.65	$173.78	$346.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $50.12 / $104.71	Professional	26	$29.51	$50.12	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $263.03	Professional	TC	$81.28	$128.82	$263.03
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $42.66 / $75.86	Facility	26	$42.66	$42.66	$75.86
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $154.88 / $398.11	Professional		$107.15	$154.88	$398.11
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.71 / $141.25	Professional	26	$32.36	$45.71	$141.25
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $19.95 / $87.10 / $363.08	Professional	52	$19.95	$87.10	$363.08
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $104.71 / $239.88	Professional	TC	$79.43	$104.71	$239.88
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $41.69 / $58.88	Facility	26	$8.91	$41.69	$58.88
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $138.04 / $309.03	Professional		$100.00	$138.04	$309.03
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $40.74 / $95.50	Professional	26	$27.54	$40.74	$95.50
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $107.15 / $257.04	Professional	TC	$72.44	$107.15	$257.04
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $151.36 / $213.80	Professional		$120.23	$151.36	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $61.66	Professional	26	$33.88	$42.66	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $109.65 / $151.36	Professional	TC	$87.10	$109.65	$151.36