Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $132.50 / $132.50 / $166.96	Facility	26	$132.50	$132.50	$166.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $606.53 / $720.28 / $1,026.17	Professional		$606.53	$720.28	$1,026.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.95 / $132.51 / $326.29	Professional	26	$115.95	$132.51	$326.29
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $247.60 / $327.29 / $427.46	Professional	52	$247.60	$327.29	$427.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $484.78 / $587.25 / $826.26	Professional	TC	$484.78	$587.25	$826.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $606.98 / $606.98 / $606.98	Professional		$606.98	$606.98	$606.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.03 / $113.94 / $148.12	Professional	26	$37.03	$113.94	$148.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $136.27 / $620.84 / $849.47	Professional		$136.27	$620.84	$849.47
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.88 / $145.74 / $145.74	Professional	26	$123.88	$145.74	$145.74
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $644.28 / $644.28 / $644.28	Professional	TC	$644.28	$644.28	$644.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $124.96 / $546.28 / $766.80	Professional		$124.96	$546.28	$766.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $590.34 / $962.16 / $1,663.16	Professional		$590.34	$962.16	$1,663.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.81 / $211.15 / $299.61	Professional	26	$100.81	$211.15	$299.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $488.97 / $784.52 / $1,363.54	Professional	TC	$488.97	$784.52	$1,363.54
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $119.30 / $132.50 / $166.96	Facility	26	$119.30	$132.50	$166.96
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $640.73 / $673.80 / $950.14	Professional		$640.73	$673.80	$950.14
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $117.82 / $132.50 / $275.51	Professional	26	$117.82	$132.50	$275.51
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $289.89 / $327.29 / $427.46	Professional	52	$289.89	$327.29	$427.46
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $501.32 / $539.58 / $744.05	Professional	TC	$501.32	$539.58	$744.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $126.02 / $486.21 / $775.19	Professional		$126.02	$486.21	$775.19
United Facility/Professional Professional Modifier Low / Median / High Price $621.10 / $745.03 / $1,047.65	Professional		$621.10	$745.03	$1,047.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.45 / $153.61 / $212.35	Professional	26	$120.45	$153.61	$212.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $486.31 / $591.12 / $791.27	Professional	TC	$486.31	$591.12	$791.27