Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $137.46 / $137.46 / $173.21	Facility	26	$137.46	$137.46	$173.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $634.83 / $777.87 / $1,067.58	Professional		$634.83	$777.87	$1,067.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.20 / $137.47 / $349.98	Professional	26	$123.20	$137.47	$349.98
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.77 / $342.47 / $461.84	Professional	52	$258.77	$342.47	$461.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $510.86 / $613.89 / $868.52	Professional	TC	$510.86	$613.89	$868.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $635.89 / $635.89 / $635.89	Professional		$635.89	$635.89	$635.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $115.01 / $142.53 / $173.57	Professional	26	$115.01	$142.53	$173.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.05 / $663.03 / $889.66	Professional		$135.05	$663.03	$889.66
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $129.22 / $152.04 / $152.04	Professional	26	$129.22	$152.04	$152.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $130.12 / $572.76 / $802.98	Professional		$130.12	$572.76	$802.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $630.61 / $1,018.78 / $1,741.77	Professional		$630.61	$1,018.78	$1,741.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.28 / $219.56 / $311.83	Professional	26	$105.28	$219.56	$311.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $513.32 / $821.98 / $1,429.93	Professional	TC	$513.32	$821.98	$1,429.93
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $124.47 / $137.46 / $173.21	Facility	26	$124.47	$137.46	$173.21
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $670.98 / $705.72 / $976.18	Professional		$670.98	$705.72	$976.18
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $123.20 / $137.47 / $329.46	Professional	26	$123.20	$137.47	$329.46
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $276.43 / $342.47 / $461.84	Professional	52	$276.43	$342.47	$461.84
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $525.74 / $570.24 / $787.44	Professional	TC	$525.74	$570.24	$787.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $126.02 / $517.54 / $815.45	Professional		$126.02	$517.54	$815.45
United Facility/Professional Professional Modifier Low / Median / High Price $648.89 / $803.60 / $1,108.08	Professional		$648.89	$803.60	$1,108.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $128.31 / $158.26 / $229.80	Professional	26	$128.31	$158.26	$229.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $511.17 / $616.33 / $894.07	Professional	TC	$511.17	$616.33	$894.07