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 Professional Modifier Low / Median / High Price $229.94 / $475.00 / $870.68	Professional		$229.94	$475.00	$870.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.78 / $140.00 / $421.89	Professional	26	$74.78	$140.00	$421.89
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $98.80 / $122.46 / $301.50	Professional	52	$98.80	$122.46	$301.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $126.37 / $184.67 / $385.24	Professional	TC	$126.37	$184.67	$385.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.23 / $150.34 / $187.93	Professional		$101.23	$150.34	$187.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.09 / $69.13 / $105.80	Professional	26	$54.09	$69.13	$105.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $85.84 / $160.94 / $160.94	Professional	TC	$85.84	$160.94	$160.94
BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.07 / $274.39 / $346.60	Professional		$104.07	$274.39	$346.60
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $111.31 / $111.31 / $111.31	Professional	26	$111.31	$111.31	$111.31
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $197.59 / $197.59 / $197.59	Professional	TC	$197.59	$197.59	$197.59
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.84 / $142.22 / $240.55	Professional		$74.84	$142.22	$240.55
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 Professional Modifier Low / Median / High Price $202.15 / $413.18 / $772.33	Professional		$202.15	$413.18	$772.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.86 / $91.59 / $174.14	Professional	26	$53.86	$91.59	$174.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $137.74 / $262.11 / $504.72	Professional	TC	$137.74	$262.11	$504.72
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $62.87 / $90.65 / $95.19	Facility	26	$62.87	$90.65	$95.19
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $229.94 / $339.89 / $646.00	Professional		$229.94	$339.89	$646.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $62.87 / $103.08 / $394.25	Professional	26	$62.87	$103.08	$394.25
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $115.69 / $122.46 / $328.47	Professional	52	$115.69	$122.46	$328.47
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $139.85 / $203.61 / $373.96	Professional	TC	$139.85	$203.61	$373.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.81 / $129.23 / $197.96	Professional		$61.81	$129.23	$197.96
United Facility/Professional Professional Modifier Low / Median / High Price $205.62 / $267.27 / $561.27	Professional		$205.62	$267.27	$561.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.23 / $82.03 / $114.23	Professional	26	$69.23	$82.03	$114.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.44 / $202.10 / $469.90	Professional	TC	$131.44	$202.10	$469.90