Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.73 / $77.73 / $81.61	Facility	26	$77.73	$77.73	$81.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $233.42 / $303.77 / $485.65	Professional		$233.42	$303.77	$485.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.86 / $76.91 / $183.11	Professional	26	$54.86	$76.91	$183.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $172.14 / $248.90 / $408.74	Professional	TC	$172.14	$248.90	$408.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.51 / $226.49 / $226.49	Professional		$138.51	$226.49	$226.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.33 / $59.67 / $113.82	Professional	26	$50.33	$59.67	$113.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.14 / $312.52 / $402.03	Professional		$89.14	$312.52	$402.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.34 / $95.34 / $95.34	Professional	26	$95.34	$95.34	$95.34
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $278.55 / $278.55 / $278.55	Professional	TC	$278.55	$278.55	$278.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $64.09 / $200.45 / $298.12	Professional		$64.09	$200.45	$298.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $222.42 / $363.05 / $587.99	Professional		$222.42	$363.05	$587.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.07 / $74.80 / $149.12	Professional	26	$46.07	$74.80	$149.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.22 / $269.63 / $467.84	Professional	TC	$157.22	$269.63	$467.84
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $49.56 / $77.73 / $81.61	Facility	26	$49.56	$77.73	$81.61
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $247.71 / $291.38 / $464.86	Professional		$247.71	$291.38	$464.86
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $49.56 / $76.97 / $152.60	Professional	26	$49.56	$76.97	$152.60
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $198.15 / $217.92 / $341.67	Professional	TC	$198.15	$217.92	$341.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $184.48 / $277.93	Professional		$35.58	$184.48	$277.93
United Facility/Professional Professional Modifier Low / Median / High Price $231.26 / $301.42 / $411.83	Professional		$231.26	$301.42	$411.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.96 / $68.40 / $107.48	Professional	26	$56.96	$68.40	$107.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $167.27 / $220.21 / $360.82	Professional	TC	$167.27	$220.21	$360.82