Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.85 / $82.85 / $87.00	Facility	26	$82.85	$82.85	$87.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $197.77 / $475.00 / $1,006.86	Professional		$197.77	$475.00	$1,006.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.15 / $140.00 / $368.28	Professional	26	$66.15	$140.00	$368.28
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $475.00 / $475.00 / $475.00	Professional	50	$475.00	$475.00	$475.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.19 / $129.59 / $237.50	Professional	52	$104.19	$129.59	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $164.81 / $249.00 / $485.75	Professional	TC	$164.81	$249.00	$485.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.72 / $159.00 / $200.30	Professional		$107.72	$159.00	$200.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.37 / $63.08 / $94.62	Professional	26	$49.37	$63.08	$94.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $98.96 / $98.96 / $98.96	Professional	TC	$98.96	$98.96	$98.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.88 / $308.25 / $685.73	Professional		$99.88	$308.25	$685.73
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.73 / $101.73 / $101.73	Professional	26	$101.73	$101.73	$101.73
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $560.46 / $659.36 / $659.36	Professional	50	$560.46	$659.36	$659.36
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $227.95 / $227.95 / $227.95	Professional	TC	$227.95	$227.95	$227.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $68.45 / $164.11 / $263.30	Professional		$68.45	$164.11	$263.30
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 $213.87 / $435.21 / $759.52	Professional		$213.87	$435.21	$759.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $77.37 / $158.09	Professional	26	$49.61	$77.37	$158.09
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $343.71 / $884.65	Professional	50	$301.29	$343.71	$884.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.62 / $297.08 / $520.85	Professional	TC	$147.62	$297.08	$520.85
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $54.14 / $82.85 / $87.00	Facility	26	$54.14	$82.85	$87.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $213.85 / $364.24 / $830.81	Professional		$213.85	$364.24	$830.81
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $54.14 / $88.55 / $320.29	Professional	26	$54.14	$88.55	$320.29
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $475.00 / $475.00 / $1,768.90	Professional	50	$475.00	$475.00	$1,768.90
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $129.59 / $301.50	Professional	52	$125.00	$129.59	$301.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $164.81 / $252.75 / $434.14	Professional	TC	$164.81	$252.75	$434.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.71 / $131.93 / $226.81	Professional		$61.71	$131.93	$226.81
United Facility/Professional Professional Modifier Low / Median / High Price $217.68 / $371.25 / $548.03	Professional		$217.68	$371.25	$548.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.92 / $70.06 / $112.40	Professional	26	$59.92	$70.06	$112.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.10 / $196.10 / $473.96	Professional	TC	$148.10	$196.10	$473.96