Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.56 / $78.56 / $82.49	Facility	26	$78.56	$78.56	$82.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $255.84 / $394.26	Professional		$171.00	$255.84	$394.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $78.56 / $188.10	Professional	26	$55.15	$78.56	$188.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $115.43 / $177.61 / $291.63	Professional	TC	$115.43	$177.61	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.46 / $104.63 / $156.96	Professional		$100.46	$104.63	$156.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.83 / $59.85 / $86.30	Professional	26	$46.83	$59.85	$86.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.14 / $203.70 / $268.08	Professional		$99.14	$203.70	$268.08
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.40 / $96.40 / $96.40	Professional	26	$96.40	$96.40	$96.40
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $161.38 / $161.38 / $161.38	Professional	TC	$161.38	$161.38	$161.38
CareSource Facility/Professional Professional Modifier Low / Median / High Price $64.81 / $116.18 / $199.49	Professional		$64.81	$116.18	$199.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $178.96 / $293.31 / $562.74	Professional		$178.96	$293.31	$562.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.30 / $72.51 / $149.22	Professional	26	$46.30	$72.51	$149.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.81 / $202.68 / $359.56	Professional	TC	$111.81	$202.68	$359.56
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $50.09 / $78.56 / $82.49	Facility	26	$50.09	$78.56	$82.49
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $179.33 / $237.13 / $375.80	Professional		$179.33	$237.13	$375.80
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $50.09 / $78.56 / $182.01	Professional	26	$50.09	$78.56	$182.01
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $116.70 / $187.04 / $255.32	Professional	TC	$116.70	$187.04	$255.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $108.90 / $159.69	Professional		$35.58	$108.90	$159.69
United Facility/Professional Professional Modifier Low / Median / High Price $174.17 / $256.93 / $389.17	Professional		$174.17	$256.93	$389.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.24 / $67.36 / $106.03	Professional	26	$57.24	$67.36	$106.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.04 / $190.32 / $304.11	Professional	TC	$123.04	$190.32	$304.11