Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.37 / $89.37 / $93.84	Facility	26	$89.37	$89.37	$93.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.89 / $475.00 / $843.00	Professional		$252.89	$475.00	$843.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.23 / $140.00 / $291.44	Professional	26	$71.23	$140.00	$291.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $119.41 / $147.10 / $237.50	Professional	52	$119.41	$147.10	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $270.36 / $441.00	Professional	TC	$187.50	$270.36	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $137.31 / $137.31 / $177.70	Professional		$137.31	$137.31	$177.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.05 / $68.66 / $102.24	Professional	26	$51.05	$68.66	$102.24
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.97 / $112.97 / $112.97	Professional	TC	$112.97	$112.97	$112.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.72 / $293.75 / $384.40	Professional		$107.72	$293.75	$384.40
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.72 / $109.72 / $109.72	Professional	26	$109.72	$109.72	$109.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $73.75 / $187.04 / $295.24	Professional		$73.75	$187.04	$295.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $266.61 / $497.28 / $859.41	Professional		$266.61	$497.28	$859.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.97 / $84.22 / $171.71	Professional	26	$52.97	$84.22	$171.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $191.06 / $344.97 / $601.40	Professional	TC	$191.06	$344.97	$601.40
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $57.84 / $89.37 / $93.84	Facility	26	$57.84	$89.37	$93.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $269.13 / $376.94 / $650.20	Professional		$269.13	$376.94	$650.20
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $57.84 / $91.69 / $211.25	Professional	26	$57.84	$91.69	$211.25
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $126.45 / $147.10 / $379.23	Professional	52	$126.45	$147.10	$379.23
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $188.15 / $307.23 / $444.45	Professional	TC	$188.15	$307.23	$444.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.62 / $158.51 / $233.43	Professional		$61.62	$158.51	$233.43
United Facility/Professional Professional Modifier Low / Median / High Price $252.12 / $424.91 / $584.25	Professional		$252.12	$424.91	$584.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.27 / $78.83 / $218.19	Professional	26	$66.27	$78.83	$218.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.32 / $339.35 / $520.14	Professional	TC	$177.32	$339.35	$520.14