Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.20 / $71.20 / $79.06	Facility	26	$71.20	$71.20	$79.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $282.66 / $521.70	Professional		$171.00	$282.66	$521.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.67 / $74.76 / $284.00	Professional	26	$53.67	$74.76	$284.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $215.99 / $375.48	Professional	TC	$119.70	$215.99	$375.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.16 / $130.58 / $165.37	Professional		$63.16	$130.58	$165.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.38 / $70.37 / $104.18	Professional	26	$42.38	$70.37	$104.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.75 / $252.97 / $341.51	Professional		$85.75	$252.97	$341.51
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.25 / $87.35 / $87.35	Professional	26	$74.25	$87.35	$87.35
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $183.21 / $183.21 / $183.21	Professional	TC	$183.21	$183.21	$183.21
CareSource Facility/Professional Professional Modifier Low / Median / High Price $58.80 / $131.88 / $216.35	Professional		$58.80	$131.88	$216.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.64 / $319.97 / $540.91	Professional		$189.64	$319.97	$540.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.54 / $71.45 / $145.84	Professional	26	$41.54	$71.45	$145.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.63 / $217.94 / $402.04	Professional	TC	$129.63	$217.94	$402.04
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $48.50 / $71.20 / $74.76	Facility	26	$48.50	$71.20	$74.76
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $189.34 / $229.19 / $432.48	Professional		$189.34	$229.19	$432.48
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $48.50 / $71.20 / $259.38	Professional	26	$48.50	$71.20	$259.38
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $132.22 / $180.68 / $304.54	Professional	TC	$132.22	$180.68	$304.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $116.15 / $192.46	Professional		$34.95	$116.15	$192.46
United Facility/Professional Professional Modifier Low / Median / High Price $184.08 / $261.24 / $396.74	Professional		$184.08	$261.24	$396.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.53 / $63.88 / $95.82	Professional	26	$54.53	$63.88	$95.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.83 / $195.98 / $297.22	Professional	TC	$123.83	$195.98	$297.22