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 $230.75 / $475.00 / $850.19	Professional		$230.75	$475.00	$850.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.29 / $134.31 / $412.13	Professional	26	$72.29	$134.31	$412.13
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $98.96 / $122.86 / $237.50	Professional	52	$98.96	$122.86	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $126.70 / $189.95 / $422.10	Professional	TC	$126.70	$189.95	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $140.83 / $160.28 / $187.11	Professional		$140.83	$160.28	$187.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.90 / $68.14 / $99.66	Professional	26	$52.90	$68.14	$99.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $86.30 / $86.30 / $86.30	Professional	TC	$86.30	$86.30	$86.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.07 / $231.86 / $391.26	Professional		$104.07	$231.86	$391.26
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.61 / $111.31 / $111.31	Professional	26	$94.61	$111.31	$111.31
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $198.66 / $198.66 / $198.66	Professional	TC	$198.66	$198.66	$198.66
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.84 / $142.99 / $241.85	Professional		$74.84	$142.99	$241.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.15 / $413.86 / $775.69	Professional		$201.15	$413.86	$775.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $86.58 / $174.14	Professional	26	$53.70	$86.58	$174.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $136.41 / $263.25 / $559.38	Professional	TC	$136.41	$263.25	$559.38
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $90.65 / $95.19	Facility	26	$58.64	$90.65	$95.19
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $236.83 / $338.03 / $688.75	Professional		$236.83	$338.03	$688.75
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $58.64 / $96.22 / $388.55	Professional	26	$58.64	$96.22	$388.55
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $116.30 / $122.86 / $301.50	Professional	52	$116.30	$122.86	$301.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $143.32 / $214.14 / $387.65	Professional	TC	$143.32	$214.14	$387.65
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 $206.01 / $298.42 / $628.19	Professional		$206.01	$298.42	$628.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.58 / $77.89 / $123.40	Professional	26	$66.58	$77.89	$123.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.12 / $188.68 / $515.12	Professional	TC	$132.12	$188.68	$515.12