Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.51 / $66.51 / $69.83	Facility	26	$66.51	$66.51	$69.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.85 / $220.65 / $351.09	Professional		$145.85	$220.65	$351.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.78 / $66.51 / $163.88	Professional	26	$46.78	$66.51	$163.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.97 / $155.88 / $285.50	Professional	TC	$90.97	$155.88	$285.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.50 / $131.19 / $131.19	Professional		$80.50	$131.19	$131.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.57 / $55.03 / $96.90	Professional	26	$40.57	$55.03	$96.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.19 / $191.60 / $242.02	Professional		$76.19	$191.60	$242.02
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.48 / $81.48 / $81.48	Professional	26	$81.48	$81.48	$81.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $54.82 / $96.59 / $167.02	Professional		$54.82	$96.59	$167.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.07 / $242.88 / $418.24	Professional		$137.07	$242.88	$418.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.81 / $63.36 / $126.94	Professional	26	$38.81	$63.36	$126.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.61 / $157.50 / $282.79	Professional	TC	$84.61	$157.50	$282.79
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $42.01 / $66.51 / $69.83	Facility	26	$42.01	$66.51	$69.83
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $150.08 / $178.24 / $293.47	Professional		$150.08	$178.24	$293.47
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $42.01 / $66.51 / $154.69	Professional	26	$42.01	$66.51	$154.69
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $97.15 / $136.22 / $242.00	Professional	TC	$97.15	$136.22	$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 $136.15 / $180.17 / $324.75	Professional		$136.15	$180.17	$324.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.48 / $56.78 / $90.39	Professional	26	$48.48	$56.78	$90.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.28 / $140.05 / $248.49	Professional	TC	$84.28	$140.05	$248.49