Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.39 / $60.39 / $76.09	Facility	26	$60.39	$60.39	$76.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.44 / $220.81 / $371.00	Professional		$141.44	$220.81	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.15 / $60.40 / $206.19	Professional	26	$46.15	$60.40	$206.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.02 / $148.06 / $286.22	Professional	TC	$92.02	$148.06	$286.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.80 / $108.83 / $128.03	Professional		$101.80	$108.83	$128.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $55.38 / $80.93	Professional	26	$36.15	$55.38	$80.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.26 / $59.26 / $59.26	Professional	TC	$59.26	$59.26	$59.26
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.70 / $152.99 / $223.62	Professional		$69.70	$152.99	$223.62
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.56 / $74.56 / $74.56	Professional	26	$74.56	$74.56	$74.56
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $136.35 / $136.35 / $136.35	Professional	TC	$136.35	$136.35	$136.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $50.27 / $98.12 / $165.84	Professional		$50.27	$98.12	$165.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.19 / $277.83 / $446.43	Professional		$159.19	$277.83	$446.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.92 / $65.37 / $119.34	Professional	26	$38.92	$65.37	$119.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.89 / $173.08 / $312.12	Professional	TC	$105.89	$173.08	$312.12
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $41.49 / $60.39 / $63.42	Facility	26	$41.49	$60.39	$63.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $147.21 / $187.51 / $351.75	Professional		$147.21	$187.51	$351.75
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $41.49 / $60.40 / $188.76	Professional	26	$41.49	$60.40	$188.76
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $98.70 / $146.02 / $242.00	Professional	TC	$98.70	$146.02	$242.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $108.90 / $159.69	Professional		$34.95	$108.90	$159.69
United Facility/Professional Professional Modifier Low / Median / High Price $142.26 / $220.45 / $316.32	Professional		$142.26	$220.45	$316.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.78 / $55.92 / $88.65	Professional	26	$47.78	$55.92	$88.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.78 / $158.02 / $243.83	Professional	TC	$97.78	$158.02	$243.83