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 $150.19 / $211.03 / $379.63	Professional		$150.19	$211.03	$379.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.45 / $60.40 / $153.56	Professional	26	$45.45	$60.40	$153.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $177.61 / $303.82	Professional	TC	$119.70	$177.61	$303.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.13 / $125.36 / $151.55	Professional		$125.13	$125.36	$151.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $46.15 / $73.41	Professional	26	$36.15	$46.15	$73.41
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $80.73 / $80.73 / $80.73	Professional	TC	$80.73	$80.73	$80.73
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.70 / $260.56 / $584.41	Professional		$69.70	$260.56	$584.41
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 50 Low / Median / High Price $520.88 / $520.88 / $520.88	Professional	50	$520.88	$520.88	$520.88
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $185.88 / $185.88 / $185.88	Professional	TC	$185.88	$185.88	$185.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $50.27 / $133.80 / $207.99	Professional		$50.27	$133.80	$207.99
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 $162.68 / $270.67 / $435.86	Professional		$162.68	$270.67	$435.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.82 / $62.36 / $117.12	Professional	26	$36.82	$62.36	$117.12
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $231.34 / $264.19 / $435.86	Professional	50	$231.34	$264.19	$435.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.53 / $192.05 / $333.41	Professional	TC	$111.53	$192.05	$333.41
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $40.04 / $60.39 / $63.42	Facility	26	$40.04	$60.39	$63.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $157.74 / $187.84 / $337.72	Professional		$157.74	$187.84	$337.72
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $40.04 / $60.39 / $151.13	Professional	26	$40.04	$60.39	$151.13
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $126.73 / $142.05 / $257.05	Professional	TC	$126.73	$142.05	$257.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $116.15 / $192.46	Professional		$34.95	$116.15	$192.46
United Facility/Professional Professional Modifier Low / Median / High Price $167.38 / $217.84 / $322.30	Professional		$167.38	$217.84	$322.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.60 / $56.21 / $82.88	Professional	26	$46.60	$56.21	$82.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $118.38 / $155.01 / $236.15	Professional	TC	$118.38	$155.01	$236.15