Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.06 / $66.06 / $69.37	Facility	26	$66.06	$66.06	$69.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.86 / $221.75 / $392.00	Professional		$145.86	$221.75	$392.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.89 / $66.06 / $210.08	Professional	26	$46.89	$66.06	$210.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $66.95 / $85.25 / $110.88	Professional	52	$66.95	$85.25	$110.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.32 / $159.05 / $291.63	Professional	TC	$91.32	$159.05	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.01 / $129.99 / $131.18	Professional		$101.01	$129.99	$131.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.47 / $54.66 / $95.76	Professional	26	$38.47	$54.66	$95.76
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $54.91 / $54.91 / $54.91	Professional	TC	$54.91	$54.91	$54.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.70 / $161.34 / $221.85	Professional		$75.70	$161.34	$221.85
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.81 / $80.95 / $80.95	Professional	26	$68.81	$80.95	$80.95
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.75 / $134.75 / $134.75	Professional	TC	$134.75	$134.75	$134.75
CareSource Facility/Professional Professional Modifier Low / Median / High Price $54.45 / $96.97 / $166.96	Professional		$54.45	$96.97	$166.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.72 / $262.97 / $446.43	Professional		$153.72	$262.97	$446.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.58 / $65.98 / $127.24	Professional	26	$38.58	$65.98	$127.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.84 / $166.29 / $308.51	Professional	TC	$96.84	$166.29	$308.51
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $39.90 / $66.06 / $69.37	Facility	26	$39.90	$66.06	$69.37
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $150.12 / $184.60 / $392.00	Professional		$150.12	$184.60	$392.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $66.06 / $161.41	Professional	26	$39.90	$66.06	$161.41
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $78.31 / $85.25 / $185.50	Professional	52	$78.31	$85.25	$185.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $97.54 / $144.69 / $243.64	Professional	TC	$97.54	$144.69	$243.64
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 $148.28 / $218.42 / $333.77	Professional		$148.28	$218.42	$333.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.57 / $59.19 / $87.14	Professional	26	$50.57	$59.19	$87.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $92.11 / $157.28 / $248.49	Professional	TC	$92.11	$157.28	$248.49