Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $131.83 / $165.96	Facility	26	$131.83	$131.83	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $724.44 / $1,548.82	Professional		$575.44	$724.44	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $190.55 / $537.03	Professional	26	$112.20	$190.55	$537.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $173.78 / $218.78 / $1,202.26	Professional	52	$173.78	$218.78	$1,202.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $562.34 / $1,096.48	Professional	TC	$457.09	$562.34	$1,096.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $575.44 / $630.96	Professional		$537.03	$575.44	$630.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $141.25 / $208.93	Professional	26	$109.65	$141.25	$208.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $501.19 / $501.19	Professional	TC	$501.19	$501.19	$501.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $741.31 / $794.33	Professional		$524.81	$741.31	$794.33
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $144.54 / $144.54	Professional	26	$144.54	$144.54	$144.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $562.34 / $758.58	Professional		$125.89	$562.34	$758.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $131.83 / $190.55	Facility	26	$28.18	$131.83	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $933.25 / $1,659.59	Professional		$602.56	$933.25	$1,659.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $177.83 / $302.00	Professional	26	$100.00	$177.83	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $741.31 / $1,348.96	Professional	TC	$489.78	$741.31	$1,348.96
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $131.83 / $316.23	Facility	26	$131.83	$131.83	$316.23
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $741.31 / $1,318.26	Professional		$602.56	$741.31	$1,318.26
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $144.54 / $346.74	Professional	26	$114.82	$144.54	$346.74
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $173.78 / $190.55 / $269.15	Professional	52	$173.78	$190.55	$269.15
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $602.56 / $977.24	Professional	TC	$478.63	$602.56	$977.24
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $131.83 / $190.55	Facility	26	$28.18	$131.83	$190.55
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $912.01 / $1,698.24	Professional		$562.34	$912.01	$1,698.24
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $173.78 / $354.81	Professional	26	$97.72	$173.78	$354.81
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $676.08 / $1,348.96	Professional	TC	$457.09	$676.08	$1,348.96
United Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $741.31 / $1,047.13	Professional		$575.44	$741.31	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $151.36 / $213.80	Professional	26	$114.82	$151.36	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $588.84 / $831.76	Professional	TC	$467.74	$588.84	$831.76