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 / $63.42	Facility	26	$60.39	$60.39	$63.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.44 / $220.22 / $353.78	Professional		$141.44	$220.22	$353.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.88 / $60.39 / $142.30	Professional	26	$44.88	$60.39	$142.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.02 / $157.83 / $291.63	Professional	TC	$92.02	$157.83	$291.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.43 / $46.15 / $81.50	Professional	26	$35.43	$46.15	$81.50
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.70 / $157.37 / $226.22	Professional		$69.70	$157.37	$226.22
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.38 / $74.56 / $74.56	Professional	26	$63.38	$74.56	$74.56
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.81 / $135.81 / $135.81	Professional	TC	$135.81	$135.81	$135.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $50.27 / $97.73 / $165.20	Professional		$50.27	$97.73	$165.20
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 $156.12 / $277.58 / $446.43	Professional		$156.12	$277.58	$446.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $62.84 / $117.12	Professional	26	$36.96	$62.84	$117.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.89 / $176.28 / $310.92	Professional	TC	$105.89	$176.28	$310.92
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $39.10 / $60.39 / $63.42	Facility	26	$39.10	$60.39	$63.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $146.81 / $184.60 / $313.42	Professional		$146.81	$184.60	$313.42
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.10 / $60.39 / $130.38	Professional	26	$39.10	$60.39	$130.38
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $98.31 / $145.49 / $242.00	Professional	TC	$98.31	$145.49	$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 $145.94 / $216.07 / $314.73	Professional		$145.94	$216.07	$314.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.15 / $57.33 / $82.88	Professional	26	$48.15	$57.33	$82.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.79 / $151.50 / $243.37	Professional	TC	$97.79	$151.50	$243.37