Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.87 / $139.87 / $146.87	Facility	26	$139.87	$139.87	$146.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $351.74 / $475.00 / $903.45	Professional		$351.74	$475.00	$903.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.26 / $165.08 / $615.45	Professional	26	$115.26	$165.08	$615.45
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $204.93 / $237.50	Professional	52	$125.00	$204.93	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $236.47 / $335.00 / $499.00	Professional	TC	$236.47	$335.00	$499.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.35 / $255.70 / $312.95	Professional		$169.35	$255.70	$312.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.14 / $107.67 / $186.78	Professional	26	$84.14	$107.67	$186.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $149.74 / $149.74 / $149.74	Professional	TC	$149.74	$149.74	$149.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $153.27 / $439.58 / $652.78	Professional		$153.27	$439.58	$652.78
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $146.68 / $172.56 / $172.56	Professional	26	$146.68	$172.56	$172.56
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $344.59 / $344.59 / $344.59	Professional	TC	$344.59	$344.59	$344.59
CareSource Facility/Professional Professional Modifier Low / Median / High Price $115.66 / $248.00 / $413.27	Professional		$115.66	$248.00	$413.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $342.87 / $685.52 / $1,228.86	Professional		$342.87	$685.52	$1,228.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.84 / $134.81 / $267.92	Professional	26	$81.84	$134.81	$267.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $242.94 / $429.04 / $1,067.46	Professional	TC	$242.94	$429.04	$1,067.46
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $92.25 / $139.87 / $146.87	Facility	26	$92.25	$139.87	$146.87
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $361.14 / $494.18 / $889.39	Professional		$361.14	$494.18	$889.39
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $92.25 / $144.00 / $615.45	Professional	26	$92.25	$144.00	$615.45
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $175.87 / $204.93 / $425.22	Professional	52	$175.87	$204.93	$425.22
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $249.38 / $338.30 / $549.32	Professional	TC	$249.38	$338.30	$549.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.51 / $198.34 / $337.76	Professional		$93.51	$198.34	$337.76
United Facility/Professional Professional Modifier Low / Median / High Price $333.58 / $555.96 / $1,077.06	Professional		$333.58	$555.96	$1,077.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.78 / $118.73 / $173.72	Professional	26	$104.78	$118.73	$173.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $230.19 / $311.54 / $962.90	Professional	TC	$230.19	$311.54	$962.90