Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.95 / $75.95 / $79.76	Facility	26	$75.95	$75.95	$79.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $196.55 / $334.68 / $427.97	Professional		$196.55	$334.68	$427.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.34 / $65.91 / $145.63	Professional	26	$59.34	$65.91	$145.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.68 / $243.40 / $358.73	Professional	TC	$136.68	$243.40	$358.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $118.14 / $141.03 / $160.83	Professional		$118.14	$141.03	$160.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.57 / $55.97 / $92.32	Professional	26	$45.57	$55.97	$92.32
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.65 / $282.43 / $401.34	Professional		$87.65	$282.43	$401.34
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.74 / $93.74 / $93.74	Professional	26	$93.74	$93.74	$93.74
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $224.22 / $224.22 / $224.22	Professional	TC	$224.22	$224.22	$224.22
CareSource Facility/Professional Professional Modifier Low / Median / High Price $63.01 / $161.38 / $253.90	Professional		$63.01	$161.38	$253.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.54 / $67.54 / $67.54	Facility	26	$67.54	$67.54	$67.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $225.44 / $388.65 / $670.82	Professional		$225.44	$388.65	$670.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.65 / $78.78 / $155.78	Professional	26	$46.65	$78.78	$155.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.27 / $266.89 / $495.31	Professional	TC	$158.27	$266.89	$495.31
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $53.53 / $75.95 / $79.76	Facility	26	$53.53	$75.95	$79.76
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $215.34 / $280.00 / $441.54	Professional		$215.34	$280.00	$441.54
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $53.53 / $69.58 / $115.20	Professional	26	$53.53	$69.58	$115.20
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $152.88 / $226.46 / $358.73	Professional	TC	$152.88	$226.46	$358.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $152.02 / $233.43	Professional		$35.58	$152.02	$233.43
United Facility/Professional Professional Modifier Low / Median / High Price $217.70 / $317.66 / $468.15	Professional		$217.70	$317.66	$468.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.96 / $71.08 / $114.18	Professional	26	$60.96	$71.08	$114.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.27 / $238.99 / $369.12	Professional	TC	$151.27	$238.99	$369.12