Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.12 / $107.12 / $112.47	Facility	26	$107.12	$107.12	$112.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $256.36 / $385.88 / $673.37	Professional		$256.36	$385.88	$673.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.65 / $107.12 / $259.91	Professional	26	$75.65	$107.12	$259.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.98 / $310.24 / $509.48	Professional	TC	$171.98	$310.24	$509.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $122.28 / $122.28 / $166.38	Professional		$122.28	$122.28	$166.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.62 / $88.48 / $121.97	Professional	26	$62.62	$88.48	$121.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.50 / $355.56 / $448.13	Professional		$122.50	$355.56	$448.13
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $131.02 / $131.02 / $131.02	Professional	26	$131.02	$131.02	$131.02
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.89 / $316.89 / $316.89	Professional	TC	$316.89	$316.89	$316.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $88.15 / $228.09 / $357.69	Professional		$88.15	$228.09	$357.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $277.48 / $505.15 / $996.87	Professional		$277.48	$505.15	$996.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.72 / $100.35 / $204.66	Professional	26	$62.72	$100.35	$204.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.47 / $348.66 / $704.64	Professional	TC	$190.47	$348.66	$704.64
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $68.42 / $107.12 / $112.47	Facility	26	$68.42	$107.12	$112.47
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $297.42 / $418.76 / $590.49	Professional		$297.42	$418.76	$590.49
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $68.42 / $107.12 / $253.13	Professional	26	$68.42	$107.12	$253.13
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $212.31 / $310.24 / $478.44	Professional	TC	$212.31	$310.24	$478.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.99 / $169.60 / $301.95	Professional		$93.99	$169.60	$301.95
United Facility/Professional Professional Modifier Low / Median / High Price $281.11 / $451.49 / $662.18	Professional		$281.11	$451.49	$662.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.48 / $92.91 / $144.88	Professional	26	$77.48	$92.91	$144.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $193.57 / $317.24 / $568.82	Professional	TC	$193.57	$317.24	$568.82