Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $138.04 / $154.88	Facility	26	$138.04	$138.04	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $776.25 / $1,412.54	Professional		$588.84	$776.25	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $199.53 / $537.03	Professional	26	$117.49	$199.53	$537.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $257.04 / $1,258.93	Professional	52	$199.53	$257.04	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $616.60 / $1,148.15	Professional	TC	$478.63	$616.60	$1,148.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $630.96 / $660.69	Professional		$575.44	$630.96	$660.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $144.54 / $208.93	Professional	26	$114.82	$144.54	$208.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $457.09 / $457.09	Professional	TC	$457.09	$457.09	$457.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $776.25 / $831.76	Professional		$645.65	$776.25	$831.76
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	26	$151.36	$151.36	$151.36
CareSource Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $588.84 / $794.33	Professional		$128.82	$588.84	$794.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $138.04 / $199.53	Facility	26	$29.51	$138.04	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $977.24 / $1,737.80	Professional		$630.96	$977.24	$1,737.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $186.21 / $309.03	Professional	26	$104.71	$186.21	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $776.25 / $1,445.44	Professional	TC	$512.86	$776.25	$1,445.44
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $138.04 / $338.84	Facility	26	$138.04	$138.04	$338.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $794.33 / $1,348.96	Professional		$630.96	$794.33	$1,348.96
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $151.36 / $371.54	Professional	26	$120.23	$151.36	$371.54
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $117.49 / $199.53 / $645.65	Professional	52	$117.49	$199.53	$645.65
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $630.96 / $1,023.29	Professional	TC	$501.19	$630.96	$1,023.29
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $138.04 / $199.53	Facility	26	$29.51	$138.04	$199.53
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $891.25 / $1,862.09	Professional		$588.84	$891.25	$1,862.09
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $181.97 / $380.19	Professional	26	$102.33	$181.97	$380.19
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $676.08 / $1,479.11	Professional	TC	$489.78	$676.08	$1,479.11
United Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $794.33 / $1,122.02	Professional		$616.60	$794.33	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $158.49 / $229.09	Professional	26	$120.23	$158.49	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $630.96 / $912.01	Professional	TC	$489.78	$630.96	$912.01