Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.24 / $109.24 / $137.63	Facility	26	$109.24	$109.24	$137.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $279.12 / $449.30 / $603.00	Professional		$279.12	$449.30	$603.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.09 / $139.52 / $199.08	Professional	26	$86.09	$139.52	$199.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $173.76 / $237.50	Professional	52	$125.00	$173.76	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $193.96 / $314.52 / $462.42	Professional	TC	$193.96	$314.52	$462.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $163.12 / $163.12 / $163.12	Professional		$163.12	$163.12	$163.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.91 / $78.64 / $107.81	Professional	26	$64.91	$78.64	$107.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $132.58 / $132.58 / $132.58	Professional	TC	$132.58	$132.58	$132.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.99 / $317.39 / $451.36	Professional		$124.99	$317.39	$451.36
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $133.68 / $133.68 / $133.68	Professional	26	$133.68	$133.68	$133.68
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $305.18 / $305.18 / $305.18	Professional	TC	$305.18	$305.18	$305.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $291.20 / $536.24 / $979.74	Professional		$291.20	$536.24	$979.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.96 / $103.04 / $208.68	Professional	26	$63.96	$103.04	$208.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.06 / $376.60 / $699.97	Professional	TC	$213.06	$376.60	$699.97
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $69.95 / $109.24 / $137.63	Facility	26	$69.95	$109.24	$137.63
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $299.02 / $423.71 / $603.00	Professional		$299.02	$423.71	$603.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $69.95 / $109.24 / $176.40	Professional	26	$69.95	$109.24	$176.40
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $149.52 / $173.76 / $375.29	Professional	52	$149.52	$173.76	$375.29
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $208.82 / $335.00 / $477.57	Professional	TC	$208.82	$335.00	$477.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.51 / $196.97 / $304.54	Professional		$93.51	$196.97	$304.54
United Facility/Professional Professional Modifier Low / Median / High Price $292.30 / $399.03 / $689.96	Professional		$292.30	$399.03	$689.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.31 / $93.34 / $147.75	Professional	26	$79.31	$93.34	$147.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.18 / $270.77 / $564.79	Professional	TC	$203.18	$270.77	$564.79