Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.17 / $52.17 / $61.88	Facility	26	$52.17	$52.17	$61.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.63 / $226.80 / $471.90	Professional		$144.63	$226.80	$471.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.90 / $54.78 / $152.13	Professional	26	$42.90	$54.78	$152.13
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.16 / $81.70 / $113.40	Professional	52	$64.16	$81.70	$113.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.54 / $166.86 / $291.63	Professional	TC	$102.54	$166.86	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.02 / $102.60 / $126.85	Professional		$63.02	$102.60	$126.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.61 / $41.80 / $63.42	Professional	26	$30.61	$41.80	$63.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.25 / $165.08 / $242.76	Professional		$60.25	$165.08	$242.76
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.77 / $64.44 / $64.44	Professional	26	$54.77	$64.44	$64.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $143.27 / $143.27 / $143.27	Professional	TC	$143.27	$143.27	$143.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.32 / $103.10 / $166.03	Professional		$43.32	$103.10	$166.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.49 / $245.52 / $459.95	Professional		$134.49	$245.52	$459.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $61.00 / $107.16	Professional	26	$33.77	$61.00	$107.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.65 / $158.88 / $306.01	Professional	TC	$91.65	$158.88	$306.01
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $44.13 / $52.17 / $54.78	Facility	26	$44.13	$52.17	$54.78
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $148.81 / $196.23 / $383.41	Professional		$148.81	$196.23	$383.41
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $43.41 / $54.21 / $142.35	Professional	26	$43.41	$54.21	$142.35
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $78.42 / $81.70 / $185.50	Professional	52	$78.42	$81.70	$185.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $104.64 / $152.11 / $245.56	Professional	TC	$104.64	$152.11	$245.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $108.90 / $159.69	Professional		$34.95	$108.90	$159.69
United Facility/Professional Professional Modifier Low / Median / High Price $134.40 / $205.74 / $285.98	Professional		$134.40	$205.74	$285.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.51 / $52.53 / $70.69	Professional	26	$41.51	$52.53	$70.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.29 / $159.80 / $227.28	Professional	TC	$91.29	$159.80	$227.28