Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.65 / $90.65 / $95.19	Facility	26	$90.65	$90.65	$95.19
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.32 / $50.35 / $80.54	Facility	53	$48.32	$50.35	$80.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $241.18 / $475.00 / $795.55	Professional		$241.18	$475.00	$795.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.90 / $125.90 / $408.00	Professional	26	$70.90	$125.90	$408.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $101.07 / $125.87 / $236.46	Professional	52	$101.07	$125.87	$236.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $153.97 / $225.45 / $423.50	Professional	TC	$153.97	$225.45	$423.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $148.99 / $154.94 / $193.67	Professional		$148.99	$154.94	$193.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.95 / $69.36 / $99.23	Professional	26	$52.95	$69.36	$99.23
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $164.62 / $164.62 / $164.62	Professional	52	$164.62	$164.62	$164.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $90.24 / $90.24 / $90.24	Professional	TC	$90.24	$90.24	$90.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.58 / $253.12 / $357.35	Professional		$103.58	$253.12	$357.35
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $110.78 / $110.78 / $110.78	Professional	26	$110.78	$110.78	$110.78
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $207.71 / $207.71 / $207.71	Professional	TC	$207.71	$207.71	$207.71
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.50 / $149.50 / $252.83	Professional		$74.50	$149.50	$252.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.46 / $422.66 / $793.43	Professional		$208.46	$422.66	$793.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.43 / $86.12 / $174.14	Professional	26	$53.43	$86.12	$174.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.05 / $272.73 / $525.35	Professional	TC	$144.05	$272.73	$525.35
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $57.43 / $90.65 / $95.19	Facility	26	$57.43	$90.65	$95.19
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $48.32 / $80.54 / $199.78	Facility	53	$48.32	$80.54	$199.78
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $241.18 / $377.61 / $648.75	Professional		$241.18	$377.61	$648.75
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $57.43 / $94.90 / $380.80	Professional	26	$57.43	$94.90	$380.80
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $120.81 / $125.87 / $301.50	Professional	52	$120.81	$125.87	$301.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $152.88 / $241.62 / $420.80	Professional	TC	$152.88	$241.62	$420.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.71 / $128.53 / $192.86	Professional		$61.71	$128.53	$192.86
United Facility/Professional Professional Modifier Low / Median / High Price $201.53 / $275.89 / $582.40	Professional		$201.53	$275.89	$582.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.78 / $76.34 / $122.28	Professional	26	$65.78	$76.34	$122.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $137.76 / $182.04 / $506.05	Professional	TC	$137.76	$182.04	$506.05