Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.45 / $82.45 / $97.93	Facility	26	$82.45	$82.45	$97.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $244.90 / $475.00 / $741.49	Professional		$244.90	$475.00	$741.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.53 / $140.00 / $291.44	Professional	26	$66.53	$140.00	$291.44
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $712.50 / $712.50 / $712.50	Professional	50	$712.50	$712.50	$712.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $281.63 / $441.00	Professional	TC	$187.50	$281.63	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $159.87 / $173.45 / $218.56	Professional		$159.87	$173.45	$218.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.38 / $61.96 / $120.32	Professional	26	$47.38	$61.96	$120.32
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.73 / $112.73 / $112.73	Professional	TC	$112.73	$112.73	$112.73
BCBS Facility/Professional Professional Modifier Low / Median / High Price $230.39 / $353.99 / $809.12	Professional		$230.39	$353.99	$809.12
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.19 / $101.19 / $101.19	Professional	26	$101.19	$101.19	$101.19
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $612.97 / $721.14 / $721.14	Professional	50	$612.97	$721.14	$721.14
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $259.38 / $259.38 / $259.38	Professional	TC	$259.38	$259.38	$259.38
CareSource Facility/Professional Professional Modifier Low / Median / High Price $68.09 / $186.67 / $287.89	Professional		$68.09	$186.67	$287.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $72.95	Facility	26	$72.95	$72.95	$72.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $261.83 / $484.26 / $845.81	Professional		$261.83	$484.26	$845.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.47 / $77.65 / $157.35	Professional	26	$48.47	$77.65	$157.35
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $338.09 / $386.61 / $906.97	Professional	50	$338.09	$386.61	$906.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $188.64 / $344.27 / $600.19	Professional	TC	$188.64	$344.27	$600.19
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $52.68 / $82.45 / $86.58	Facility	26	$52.68	$82.45	$86.58
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $253.53 / $368.59 / $655.50	Professional		$253.53	$368.59	$655.50
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $52.68 / $84.28 / $178.93	Professional	26	$52.68	$84.28	$178.93
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $712.50 / $712.50 / $712.50	Professional	50	$712.50	$712.50	$712.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $187.75 / $306.63 / $441.00	Professional	TC	$187.75	$306.63	$441.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $171.84 / $242.59	Professional		$35.58	$171.84	$242.59
United Facility/Professional Professional Modifier Low / Median / High Price $222.40 / $412.63 / $617.99	Professional		$222.40	$412.63	$617.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.28 / $70.81 / $111.85	Professional	26	$60.28	$70.81	$111.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $178.09 / $333.76 / $489.77	Professional	TC	$178.09	$333.76	$489.77