Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.57 / $84.57 / $88.80	Facility	26	$84.57	$84.57	$88.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.03 / $281.16 / $508.47	Professional		$189.03	$281.16	$508.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.38 / $84.58 / $209.88	Professional	26	$61.38	$84.58	$209.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $122.22 / $211.54 / $364.25	Professional	TC	$122.22	$211.54	$364.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $111.13 / $144.22 / $144.22	Professional		$111.13	$144.22	$144.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.15 / $68.34 / $122.86	Professional	26	$50.15	$68.34	$122.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.45 / $246.05 / $319.68	Professional		$107.45	$246.05	$319.68
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.32 / $103.32 / $103.32	Professional	26	$103.32	$103.32	$103.32
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.93 / $194.93 / $194.93	Professional	TC	$194.93	$194.93	$194.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $69.56 / $140.31 / $237.33	Professional		$69.56	$140.31	$237.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.84 / $74.84 / $74.84	Facility	26	$74.84	$74.84	$74.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $196.02 / $317.70 / $547.46	Professional		$196.02	$317.70	$547.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.70 / $77.89 / $161.37	Professional	26	$49.70	$77.89	$161.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.94 / $217.36 / $399.47	Professional	TC	$128.94	$217.36	$399.47
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $53.79 / $84.57 / $88.80	Facility	26	$53.79	$84.57	$88.80
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $208.18 / $242.42 / $412.50	Professional		$208.18	$242.42	$412.50
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $53.79 / $84.57 / $208.56	Professional	26	$53.79	$84.57	$208.56
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $141.03 / $177.25 / $285.00	Professional	TC	$141.03	$177.25	$285.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.71 / $128.53 / $192.86	Professional		$61.71	$128.53	$192.86
United Facility/Professional Professional Modifier Low / Median / High Price $179.94 / $255.70 / $395.13	Professional		$179.94	$255.70	$395.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.55 / $72.56 / $114.72	Professional	26	$61.55	$72.56	$114.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.53 / $195.37 / $292.82	Professional	TC	$131.53	$195.37	$292.82