Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.51 / $72.51 / $91.37	Facility	26	$72.51	$72.51	$91.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $149.62 / $223.90 / $274.81	Professional		$149.62	$223.90	$274.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $60.32 / $124.55	Professional	26	$51.28	$60.32	$124.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.92 / $143.43 / $214.94	Professional	TC	$89.92	$143.43	$214.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $82.57 / $82.57 / $82.57	Professional		$82.57	$82.57	$82.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.15 / $55.10 / $106.12	Professional	26	$43.15	$55.10	$106.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.16 / $196.33 / $247.99	Professional		$83.16	$196.33	$247.99
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.59 / $88.94 / $88.94	Professional	26	$75.59	$88.94	$88.94
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $132.08 / $132.08 / $132.08	Professional	TC	$132.08	$132.08	$132.08
CareSource Facility/Professional Professional Modifier Low / Median / High Price $59.92 / $95.06 / $171.54	Professional		$59.92	$95.06	$171.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $64.44	Facility	26	$64.44	$64.44	$64.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $140.31 / $258.27 / $425.29	Professional		$140.31	$258.27	$425.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.40 / $67.59 / $139.40	Professional	26	$43.40	$67.59	$139.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.28 / $157.50 / $279.62	Professional	TC	$83.28	$157.50	$279.62
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $46.66 / $72.51 / $91.37	Facility	26	$46.66	$72.51	$91.37
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $153.44 / $182.35 / $286.85	Professional		$153.44	$182.35	$286.85
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $46.66 / $67.84 / $109.90	Professional	26	$46.66	$67.84	$109.90
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $95.20 / $135.69 / $214.94	Professional	TC	$95.20	$135.69	$214.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.57 / $78.84 / $152.74	Professional		$35.57	$78.84	$152.74
United Facility/Professional Professional Modifier Low / Median / High Price $140.57 / $185.33 / $318.05	Professional		$140.57	$185.33	$318.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.47 / $62.47 / $98.53	Professional	26	$53.47	$62.47	$98.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.26 / $108.71 / $230.96	Professional	TC	$82.26	$108.71	$230.96