Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.03 / $43.03 / $54.21	Facility	26	$43.03	$43.03	$54.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.65 / $145.71 / $250.21	Professional		$119.65	$145.71	$250.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.71 / $43.03 / $147.25	Professional	26	$32.71	$43.03	$147.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.17 / $70.03 / $124.93	Professional	52	$17.17	$70.03	$124.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.04 / $102.68 / $213.35	Professional	TC	$87.04	$102.68	$213.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $90.86 / $106.20 / $124.94	Professional		$90.86	$106.20	$124.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $42.97 / $58.10	Professional	26	$27.34	$42.97	$58.10
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $31.10 / $31.10 / $31.10	Professional	52	$31.10	$31.10	$31.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.77 / $120.26 / $159.44	Professional	TC	$81.77	$120.26	$159.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.78 / $151.72 / $230.06	Professional		$53.78	$151.72	$230.06
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.89 / $57.52 / $57.52	Professional	26	$48.89	$57.52	$57.52
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.40 / $147.53 / $147.53	Professional	TC	$125.40	$147.53	$147.53
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.59 / $106.16 / $163.60	Professional		$38.59	$106.16	$163.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.80 / $167.79 / $283.73	Professional		$108.80	$167.79	$283.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.10 / $44.59 / $90.19	Professional	26	$28.10	$44.59	$90.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.78 / $122.80 / $211.89	Professional	TC	$79.78	$122.80	$211.89
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $28.56 / $43.03 / $45.18	Facility	26	$28.56	$43.03	$45.18
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $145.71 / $240.90	Professional		$102.94	$145.71	$240.90
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.56 / $43.03 / $141.69	Professional	26	$28.56	$43.03	$141.69
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $39.93 / $70.03 / $124.93	Professional	52	$39.93	$70.03	$124.93
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $74.38 / $102.68 / $180.62	Professional	TC	$74.38	$102.68	$180.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $109.80 / $162.35	Professional		$35.58	$109.80	$162.35
United Facility/Professional Professional Modifier Low / Median / High Price $123.98 / $151.35 / $213.54	Professional		$123.98	$151.35	$213.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.44 / $42.74 / $60.68	Professional	26	$34.44	$42.74	$60.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.80 / $105.34 / $149.96	Professional	TC	$88.80	$105.34	$149.96