Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.78 / $51.78 / $54.36	Facility	26	$51.78	$51.78	$54.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.53 / $179.16 / $399.63	Professional		$120.53	$179.16	$399.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.49 / $51.78 / $167.63	Professional	26	$38.49	$51.78	$167.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.12 / $131.91 / $263.31	Professional	TC	$78.12	$131.91	$263.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.06 / $89.51 / $105.31	Professional		$81.06	$89.51	$105.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.54 / $41.48 / $73.20	Professional	26	$30.54	$41.48	$73.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $47.44 / $47.44 / $47.44	Professional	TC	$47.44	$47.44	$47.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.76 / $153.76 / $194.22	Professional		$59.76	$153.76	$194.22
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.32 / $63.91 / $63.91	Professional	26	$54.32	$63.91	$63.91
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $109.18 / $109.18 / $109.18	Professional	TC	$109.18	$109.18	$109.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $42.98 / $78.59 / $133.90	Professional		$42.98	$78.59	$133.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.95 / $216.16 / $345.80	Professional		$109.95	$216.16	$345.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.21 / $50.10 / $100.01	Professional	26	$30.21	$50.10	$100.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.67 / $134.68 / $240.40	Professional	TC	$67.67	$134.68	$240.40
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $32.82 / $51.78 / $53.32	Facility	26	$32.82	$51.78	$53.32
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $123.59 / $147.43 / $376.37	Professional		$123.59	$147.43	$376.37
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $34.75 / $51.78 / $131.40	Professional	26	$34.75	$51.78	$131.40
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $79.01 / $111.61 / $204.30	Professional	TC	$79.01	$111.61	$204.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $76.59 / $117.12	Professional		$34.95	$76.59	$117.12
United Facility/Professional Professional Modifier Low / Median / High Price $111.43 / $170.52 / $258.02	Professional		$111.43	$170.52	$258.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.09 / $44.19 / $70.69	Professional	26	$38.09	$44.19	$70.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.62 / $88.34 / $188.44	Professional	TC	$67.62	$88.34	$188.44