Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.28 / $49.28 / $62.09	Facility	26	$49.28	$49.28	$62.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.47 / $169.16 / $254.00	Professional		$98.47	$169.16	$254.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.64 / $59.28 / $109.01	Professional	26	$45.64	$59.28	$109.01
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.14 / $51.40 / $108.54	Professional	52	$46.14	$51.40	$108.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.38 / $91.62 / $151.75	Professional	TC	$51.38	$91.62	$151.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.97 / $93.55 / $93.55	Professional		$87.97	$93.55	$93.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.94 / $53.05 / $73.69	Professional	26	$40.94	$53.05	$73.69
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.39 / $23.39 / $23.39	Professional	52	$23.39	$23.39	$23.39
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $47.02 / $47.02 / $47.02	Professional	TC	$47.02	$47.02	$47.02
BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.40 / $133.88 / $198.97	Professional		$52.40	$133.88	$198.97
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.40 / $68.70 / $68.70	Professional	26	$58.40	$68.70	$68.70
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.68 / $84.68 / $84.68	Professional	TC	$84.68	$84.68	$84.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $46.38 / $61.01 / $119.64	Professional		$46.38	$61.01	$119.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.54 / $211.43 / $304.58	Professional		$92.54	$211.43	$304.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.73 / $91.50 / $111.81	Professional	26	$41.73	$91.50	$111.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.81 / $129.54 / $191.75	Professional	TC	$50.81	$129.54	$191.75
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $49.28 / $52.62 / $62.09	Facility	26	$49.28	$52.62	$62.09
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $100.89 / $158.75 / $241.28	Professional		$100.89	$158.75	$241.28
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $46.45 / $59.28 / $95.91	Professional	26	$46.45	$59.28	$95.91
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $46.61 / $50.45 / $95.68	Professional	52	$46.61	$50.45	$95.68
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $51.60 / $70.44 / $139.60	Professional	TC	$51.60	$70.44	$139.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.68 / $78.19 / $122.43	Professional		$35.68	$78.19	$122.43
United Facility/Professional Professional Modifier Low / Median / High Price $109.96 / $196.33 / $263.32	Professional		$109.96	$196.33	$263.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.19 / $71.23 / $102.06	Professional	26	$46.19	$71.23	$102.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.66 / $122.63 / $156.38	Professional	TC	$66.66	$122.63	$156.38