Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.66 / $131.66 / $165.89	Facility	26	$131.66	$131.66	$165.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $300.04 / $379.34 / $503.30	Professional		$300.04	$379.34	$503.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.56 / $121.40 / $228.45	Professional	26	$101.56	$121.40	$228.45
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $150.02 / $170.00 / $213.01	Professional	52	$150.02	$170.00	$213.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $198.49 / $257.76 / $410.83	Professional	TC	$198.49	$257.76	$410.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $103.02 / $103.02 / $103.02	Professional	26	$103.02	$103.02	$103.02
BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.67 / $316.22 / $562.76	Professional		$95.67	$316.22	$562.76
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.53 / $162.97 / $162.97	Professional	26	$138.53	$162.97	$162.97
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $378.15 / $378.15 / $378.15	Professional	TC	$378.15	$378.15	$378.15
CareSource Facility/Professional Professional Modifier Low / Median / High Price $98.74 / $264.33 / $397.15	Professional		$98.74	$264.33	$397.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $322.83 / $379.99 / $758.75	Professional		$322.83	$379.99	$758.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.86 / $121.24 / $214.00	Professional	26	$95.86	$121.24	$214.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $205.13 / $288.50 / $541.77	Professional	TC	$205.13	$288.50	$541.77
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $104.97 / $104.97 / $165.89	Facility	26	$104.97	$104.97	$165.89
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $307.17 / $396.67 / $565.54	Professional		$307.17	$396.67	$565.54
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $104.97 / $130.63 / $228.45	Professional	26	$104.97	$130.63	$228.45
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $150.02 / $170.00 / $213.01	Professional	52	$150.02	$170.00	$213.01
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $202.20 / $260.68 / $399.65	Professional	TC	$202.20	$260.68	$399.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $94.22 / $237.47 / $399.31	Professional		$94.22	$237.47	$399.31
United Facility/Professional Professional Modifier Low / Median / High Price $341.27 / $407.29 / $577.44	Professional		$341.27	$407.29	$577.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $118.30 / $143.94 / $189.52	Professional	26	$118.30	$143.94	$189.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $221.67 / $265.74 / $400.31	Professional	TC	$221.67	$265.74	$400.31