Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.06 / $69.06 / $72.53	Facility	26	$69.06	$69.06	$72.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $166.47 / $258.18 / $458.16	Professional		$166.47	$258.18	$458.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.50 / $69.08 / $213.84	Professional	26	$54.50	$69.08	$213.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.53 / $175.62 / $379.60	Professional	TC	$109.53	$175.62	$379.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.73 / $119.24 / $119.24	Professional		$80.73	$119.24	$119.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.11 / $53.02 / $85.64	Professional	26	$41.11	$53.02	$85.64
BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.18 / $219.03 / $288.20	Professional		$79.18	$219.03	$288.20
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.68 / $84.68 / $84.68	Professional	26	$84.68	$84.68	$84.68
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $161.91 / $161.91 / $161.91	Professional	TC	$161.91	$161.91	$161.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $56.99 / $116.56 / $197.25	Professional		$56.99	$116.56	$197.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.98 / $60.98 / $60.98	Facility	26	$60.98	$60.98	$60.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.60 / $300.99 / $547.91	Professional		$161.60	$300.99	$547.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.02 / $70.93 / $131.79	Professional	26	$44.02	$70.93	$131.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.83 / $194.09 / $361.91	Professional	TC	$104.83	$194.09	$361.91
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $50.62 / $69.06 / $70.31	Facility	26	$50.62	$69.06	$70.31
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $172.12 / $236.34 / $377.14	Professional		$172.12	$236.34	$377.14
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $50.62 / $69.06 / $184.64	Professional	26	$50.62	$69.06	$184.64
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $117.07 / $185.71 / $287.80	Professional	TC	$117.07	$185.71	$287.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $108.90 / $159.69	Professional		$34.95	$108.90	$159.69
United Facility/Professional Professional Modifier Low / Median / High Price $161.13 / $254.43 / $373.76	Professional		$161.13	$254.43	$373.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.98 / $66.61 / $105.22	Professional	26	$53.98	$66.61	$105.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.10 / $172.11 / $305.14	Professional	TC	$105.10	$172.11	$305.14