Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.26 / $83.26 / $104.90	Facility	26	$83.26	$83.26	$104.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.69 / $475.00 / $971.50	Professional		$208.69	$475.00	$971.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.63 / $140.00 / $275.88	Professional	26	$68.63	$140.00	$275.88
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,218.00 / $1,218.00 / $1,218.00	Professional	50	$1,218.00	$1,218.00	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.35 / $129.80 / $237.50	Professional	52	$104.35	$129.80	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.29 / $244.20 / $422.10	Professional	TC	$154.29	$244.20	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.31 / $163.10 / $200.61	Professional		$100.31	$163.10	$200.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.33 / $60.68 / $120.92	Professional	26	$48.33	$60.68	$120.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $99.19 / $99.19 / $99.19	Professional	TC	$99.19	$99.19	$99.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.36 / $308.75 / $740.99	Professional		$90.36	$308.75	$740.99
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $86.47 / $101.73 / $101.73	Professional	26	$86.47	$101.73	$101.73
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $561.36 / $660.42 / $660.42	Professional	50	$561.36	$660.42	$660.42
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $228.49 / $228.49 / $228.49	Professional	TC	$228.49	$228.49	$228.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $68.45 / $164.49 / $263.73	Professional		$68.45	$164.49	$263.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $214.20 / $435.88 / $751.17	Professional		$214.20	$435.88	$751.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $79.09 / $160.94	Professional	26	$49.61	$79.09	$160.94
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $343.71 / $868.20	Professional	50	$301.29	$343.71	$868.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.68 / $297.50 / $511.65	Professional	TC	$154.68	$297.50	$511.65
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $54.14 / $83.26 / $98.41	Facility	26	$54.14	$83.26	$98.41
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $231.34 / $356.30 / $778.98	Professional		$231.34	$356.30	$778.98
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $54.14 / $87.22 / $220.22	Professional	26	$54.14	$87.22	$220.22
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $1,218.00 / $1,218.00 / $1,218.00	Professional	50	$1,218.00	$1,218.00	$1,218.00
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $129.80 / $301.50	Professional	52	$125.00	$129.80	$301.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $165.19 / $249.00 / $407.90	Professional	TC	$165.19	$249.00	$407.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.71 / $132.06 / $226.81	Professional		$61.71	$132.06	$226.81
United Facility/Professional Professional Modifier Low / Median / High Price $218.03 / $315.45 / $539.69	Professional		$218.03	$315.45	$539.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.01 / $72.27 / $112.94	Professional	26	$62.01	$72.27	$112.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.19 / $244.69 / $469.82	Professional	TC	$150.19	$244.69	$469.82