Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $130.46 / $130.46 / $164.37	Facility	26	$130.46	$130.46	$164.37
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $167.17 / $167.17 / $167.17	Facility	53	$167.17	$167.17	$167.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $739.49 / $954.60 / $1,760.24	Professional		$739.49	$954.60	$1,760.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.45 / $187.33 / $550.84	Professional	26	$115.45	$187.33	$550.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $335.54 / $417.94 / $425.28	Professional	52	$335.54	$417.94	$425.28
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $137.60 / $167.17 / $174.64	Professional	53	$137.60	$167.17	$174.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $630.39 / $767.25 / $1,108.33	Professional	TC	$630.39	$767.25	$1,108.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $669.15 / $669.15 / $669.15	Professional		$669.15	$669.15	$669.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $107.90 / $107.90 / $107.90	Professional	26	$107.90	$107.90	$107.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $561.25 / $561.25 / $561.25	Professional	TC	$561.25	$561.25	$561.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $164.34 / $988.27 / $1,404.38	Professional		$164.34	$988.27	$1,404.38
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $149.40 / $175.76 / $175.76	Professional	26	$149.40	$175.76	$175.76
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $936.84 / $936.84 / $936.84	Professional	TC	$936.84	$936.84	$936.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $686.09 / $1,022.16 / $1,946.35	Professional		$686.09	$1,022.16	$1,946.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.37 / $191.36 / $334.25	Professional	26	$110.37	$191.36	$334.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $545.71 / $843.79 / $1,640.69	Professional	TC	$545.71	$843.79	$1,640.69
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $130.46 / $191.81 / $191.81	Facility	26	$130.46	$191.81	$191.81
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $167.17 / $167.17 / $167.17	Facility	53	$167.17	$167.17	$167.17
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $794.64 / $908.22 / $1,444.58	Professional		$794.64	$908.22	$1,444.58
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $122.86 / $187.33 / $407.11	Professional	26	$122.86	$187.33	$407.11
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $303.93 / $417.94 / $609.69	Professional	52	$303.93	$417.94	$609.69
Health Alliance Plan Facility/Professional Professional Modifier 53 Low / Median / High Price $139.12 / $167.17 / $370.77	Professional	53	$139.12	$167.17	$370.77
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $644.76 / $716.41 / $1,002.97	Professional	TC	$644.76	$716.41	$1,002.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.78 / $570.23 / $846.09	Professional		$93.78	$570.23	$846.09
United Facility/Professional Professional Modifier Low / Median / High Price $824.36 / $967.45 / $1,437.43	Professional		$824.36	$967.45	$1,437.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $130.38 / $188.81 / $252.30	Professional	26	$130.38	$188.81	$252.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $641.35 / $788.63 / $1,187.11	Professional	TC	$641.35	$788.63	$1,187.11