Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.43 / $39.43 / $49.69	Facility	26	$39.43	$39.43	$49.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.34 / $143.38 / $380.47	Professional		$113.34	$143.38	$380.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $45.74 / $164.00	Professional	26	$29.75	$45.74	$164.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $39.52 / $68.29 / $249.00	Professional	52	$39.52	$68.29	$249.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.78 / $97.13 / $191.61	Professional	TC	$77.78	$97.13	$191.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.25 / $102.94 / $191.57	Professional		$83.25	$102.94	$191.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.44 / $35.24 / $64.31	Professional	26	$24.44	$35.24	$64.31
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $21.90 / $21.90 / $21.90	Professional	52	$21.90	$21.90	$21.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $69.56 / $81.80 / $135.56	Professional	TC	$69.56	$81.80	$135.56
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.80 / $167.00 / $210.95	Professional		$48.80	$167.00	$210.95
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.19 / $52.19 / $52.19	Professional	26	$52.19	$52.19	$52.19
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.81 / $135.81 / $135.81	Professional	TC	$135.81	$135.81	$135.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.11 / $97.79 / $143.52	Professional		$35.11	$97.79	$143.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.11 / $144.27 / $320.24	Professional		$99.11	$144.27	$320.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.72 / $40.46 / $97.00	Professional	26	$26.72	$40.46	$97.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.94 / $99.58 / $249.12	Professional	TC	$65.94	$99.58	$249.12
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $26.80 / $39.43 / $44.27	Facility	26	$26.80	$39.43	$44.27
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $101.10 / $136.57 / $341.51	Professional		$101.10	$136.57	$341.51
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $26.80 / $40.86 / $124.15	Professional	26	$26.80	$40.86	$124.15
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $52.86 / $68.29 / $273.00	Professional	52	$52.86	$68.29	$273.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $74.31 / $97.12 / $162.00	Professional	TC	$74.31	$97.12	$162.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.56 / $112.04 / $169.81	Professional		$36.56	$112.04	$169.81
United Facility/Professional Professional Modifier Low / Median / High Price $95.51 / $127.24 / $193.05	Professional		$95.51	$127.24	$193.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.58 / $36.36 / $50.94	Professional	26	$29.58	$36.36	$50.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.20 / $89.86 / $122.89	Professional	TC	$70.20	$89.86	$122.89