Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $15.85 / $19.50	Facility	26	$15.49	$15.85	$19.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $54.95 / $154.88	Professional		$34.67	$54.95	$154.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.62 / $52.48	Professional	26	$10.96	$18.62	$52.48
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.77 / $144.54 / $144.54	Professional	52	$46.77	$144.54	$144.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $34.67 / $64.57	Professional	TC	$22.39	$34.67	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $51.29 / $75.86	Professional		$32.36	$51.29	$75.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $17.78 / $29.51	Professional	26	$11.22	$17.78	$29.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $33.11 / $45.71	Professional	TC	$30.90	$33.11	$45.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $67.61 / $72.44	Professional		$47.86	$67.61	$72.44
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $20.89 / $28.18	Professional	26	$20.89	$20.89	$28.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $51.29 / $51.29	Professional	TC	$43.65	$51.29	$51.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $37.15 / $63.10	Professional		$14.45	$37.15	$63.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.16 / $14.79 / $21.38	Facility	26	$3.16	$14.79	$21.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $53.70 / $123.03	Professional		$32.36	$53.70	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $18.62 / $38.90	Professional	26	$11.22	$18.62	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $38.90 / $91.20	Professional	TC	$20.89	$38.90	$91.20
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $15.14 / $16.22 / $35.48	Facility	26	$15.14	$16.22	$35.48
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $51.29 / $120.23	Professional		$34.67	$51.29	$120.23
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $16.98 / $43.65	Professional	26	$12.02	$16.98	$43.65
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $46.77 / $46.77 / $144.54	Professional	52	$46.77	$46.77	$144.54
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $35.48 / $63.10	Professional	TC	$21.88	$35.48	$63.10
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $3.16 / $14.79 / $21.38	Facility	26	$3.16	$14.79	$21.38
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $42.66 / $97.72	Professional		$30.20	$42.66	$97.72
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.79 / $33.88	Professional	26	$9.55	$14.79	$33.88
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $31.62 / $89.13	Professional	TC	$19.05	$31.62	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $42.66 / $67.61	Professional		$35.48	$42.66	$67.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $14.79 / $23.44	Professional	26	$12.30	$14.79	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $28.84 / $45.71	Professional	TC	$22.91	$28.84	$45.71