Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $140.00 / $176.40	Facility	26	$140.00	$140.00	$176.40
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $49.31 / $49.31 / $60.87	Facility	53	$49.31	$49.31	$60.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.77 / $330.43 / $509.07	Professional		$252.77	$330.43	$509.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.06 / $140.00 / $412.50	Professional	26	$99.06	$140.00	$412.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $95.26 / $102.43 / $184.37	Professional	26	$95.26	$102.43	$184.37
BCBS Facility/Professional Professional Modifier Low / Median / High Price $155.37 / $286.35 / $399.15	Professional		$155.37	$286.35	$399.15
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $166.17 / $166.17 / $166.17	Professional	26	$166.17	$166.17	$166.17
CareSource Facility/Professional Professional Modifier Low / Median / High Price $109.25 / $147.81 / $276.72	Professional		$109.25	$147.81	$276.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.36 / $120.36 / $120.36	Facility	26	$120.36	$120.36	$120.36
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $52.64 / $52.64 / $52.64	Facility	53	$52.64	$52.64	$52.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.39 / $348.39 / $693.48	Professional		$245.39	$348.39	$693.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.98 / $148.97 / $307.54	Professional	26	$108.98	$148.97	$307.54
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $103.82 / $140.00 / $147.00	Facility	26	$103.82	$140.00	$147.00
Health Alliance Plan Facility/Professional Facility Modifier 53 Low / Median / High Price $49.31 / $77.66 / $77.66	Facility	53	$49.31	$77.66	$77.66
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $253.20 / $305.88 / $479.00	Professional		$253.20	$305.88	$479.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $102.43 / $128.22 / $289.23	Professional	26	$102.43	$128.22	$289.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $94.06 / $145.31 / $271.44	Professional		$94.06	$145.31	$271.44
United Facility/Professional Professional Modifier Low / Median / High Price $250.87 / $338.60 / $482.93	Professional		$250.87	$338.60	$482.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.97 / $131.40 / $180.68	Professional	26	$106.97	$131.40	$180.68