Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.25 / $74.25 / $77.95	Facility	26	$74.25	$74.25	$77.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $172.80 / $282.06 / $450.50	Professional		$172.80	$282.06	$450.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $62.84 / $120.79	Professional	26	$52.78	$62.84	$120.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $215.99 / $376.52	Professional	TC	$119.70	$215.99	$376.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.17 / $73.34 / $76.13	Professional	26	$44.17	$73.34	$76.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.15 / $243.64 / $307.75	Professional		$85.15	$243.64	$307.75
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.07 / $91.07 / $91.07	Professional	26	$91.07	$91.07	$91.07
CareSource Facility/Professional Professional Modifier Low / Median / High Price $61.38 / $131.88 / $219.51	Professional		$61.38	$131.88	$219.51
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $207.98 / $335.44 / $538.07	Professional		$207.98	$335.44	$538.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.10 / $71.98 / $142.66	Professional	26	$44.10	$71.98	$142.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $140.85 / $226.23 / $402.04	Professional	TC	$140.85	$226.23	$402.04
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $47.71 / $74.25 / $75.58	Facility	26	$47.71	$74.25	$75.58
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $191.75 / $228.93 / $371.00	Professional		$191.75	$228.93	$371.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $47.71 / $69.92 / $111.38	Professional	26	$47.71	$69.92	$111.38
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $132.22 / $181.21 / $289.93	Professional	TC	$132.22	$181.21	$289.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $116.15 / $192.46	Professional		$35.58	$116.15	$192.46
United Facility/Professional Professional Modifier Low / Median / High Price $183.45 / $259.93 / $397.70	Professional		$183.45	$259.93	$397.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.53 / $63.95 / $100.85	Professional	26	$53.53	$63.95	$100.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.82 / $195.70 / $300.10	Professional	TC	$124.82	$195.70	$300.10