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 $141.10 / $221.44 / $503.74	Professional		$141.10	$221.44	$503.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.45 / $60.40 / $180.84	Professional	26	$45.45	$60.40	$180.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $204.97 / $204.97 / $204.97	Professional	50	$204.97	$204.97	$204.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.67 / $150.26 / $291.63	Professional	TC	$91.67	$150.26	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $54.28 / $98.32 / $108.56	Professional		$54.28	$98.32	$108.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $46.15 / $72.58	Professional	26	$36.15	$46.15	$72.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.03 / $59.03 / $59.03	Professional	TC	$59.03	$59.03	$59.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.68 / $210.38 / $472.09	Professional		$76.68	$210.38	$472.09
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 $420.76 / $420.76 / $420.76	Professional	50	$420.76	$420.76	$420.76
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 / $256.52 / $436.45	Professional		$156.12	$256.52	$436.45
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 $231.80 / $264.70 / $436.45	Professional	50	$231.80	$264.70	$436.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.89 / $170.72 / $309.70	Professional	TC	$105.89	$170.72	$309.70
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $39.78 / $60.39 / $63.42	Facility	26	$39.78	$60.39	$63.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $148.65 / $182.35 / $412.50	Professional		$148.65	$182.35	$412.50
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.78 / $60.39 / $154.41	Professional	26	$39.78	$60.39	$154.41
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $97.88 / $142.58 / $255.18	Professional	TC	$97.88	$142.58	$255.18
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 $145.27 / $206.95 / $313.07	Professional		$145.27	$206.95	$313.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.02 / $56.38 / $147.55	Professional	26	$45.02	$56.38	$147.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.73 / $148.54 / $233.42	Professional	TC	$90.73	$148.54	$233.42