Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.06 / $66.06 / $69.37	Facility	26	$66.06	$66.06	$69.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.40 / $171.00 / $233.05	Professional		$134.40	$171.00	$233.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.28 / $66.06 / $240.87	Professional	26	$48.28	$66.06	$240.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.29 / $110.04 / $154.96	Professional	TC	$88.29	$110.04	$154.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.55 / $116.74 / $135.88	Professional		$104.55	$116.74	$135.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $65.34 / $72.48	Professional	26	$37.88	$65.34	$72.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.70 / $198.22 / $239.95	Professional		$75.70	$198.22	$239.95
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.81 / $80.95 / $80.95	Professional	26	$68.81	$80.95	$80.95
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $142.19 / $142.19 / $142.19	Professional	TC	$142.19	$142.19	$142.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $54.45 / $102.39 / $173.77	Professional		$54.45	$102.39	$173.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.04 / $204.32 / $400.27	Professional		$123.04	$204.32	$400.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.58 / $62.80 / $125.35	Professional	26	$38.58	$62.80	$125.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.09 / $132.38 / $244.93	Professional	TC	$79.09	$132.38	$244.93
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $41.10 / $66.06 / $67.25	Facility	26	$41.10	$66.06	$67.25
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $115.30 / $165.26 / $254.34	Professional		$115.30	$165.26	$254.34
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $41.10 / $64.53 / $159.57	Professional	26	$41.10	$64.53	$159.57
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $74.20 / $110.04 / $165.09	Professional	TC	$74.20	$110.04	$165.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $109.80 / $162.35	Professional		$35.58	$109.80	$162.35
United Facility/Professional Professional Modifier Low / Median / High Price $135.78 / $159.56 / $237.11	Professional		$135.78	$159.56	$237.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.90 / $56.93 / $87.58	Professional	26	$48.90	$56.93	$87.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.30 / $103.57 / $155.36	Professional	TC	$88.30	$103.57	$155.36