Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.68 / $106.68 / $112.01	Facility	26	$106.68	$106.68	$112.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $187.76 / $235.65 / $538.52	Professional		$187.76	$235.65	$538.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.20 / $106.68 / $251.75	Professional	26	$77.20	$106.68	$251.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.95 / $136.56 / $247.90	Professional	TC	$114.95	$136.56	$247.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $140.04 / $151.16 / $287.27	Professional		$140.04	$151.16	$287.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.75 / $95.08 / $155.13	Professional	26	$62.75	$95.08	$155.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $136.16 / $136.16 / $136.16	Professional	TC	$136.16	$136.16	$136.16
BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.01 / $264.45 / $320.13	Professional		$122.01	$264.45	$320.13
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $110.92 / $130.49 / $130.49	Professional	26	$110.92	$130.49	$130.49
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $167.24 / $167.24 / $167.24	Professional	TC	$167.24	$167.24	$167.24
CareSource Facility/Professional Professional Modifier Low / Median / High Price $87.78 / $122.43 / $231.87	Professional		$87.78	$122.43	$231.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $180.16 / $267.37 / $494.96	Professional		$180.16	$267.37	$494.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.76 / $102.60 / $203.82	Professional	26	$64.76	$102.60	$203.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.50 / $156.12 / $305.82	Professional	TC	$102.50	$156.12	$305.82
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $66.83 / $106.68 / $108.60	Facility	26	$66.83	$106.68	$108.60
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $178.19 / $235.65 / $498.65	Professional		$178.19	$235.65	$498.65
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $66.83 / $106.68 / $247.41	Professional	26	$66.83	$106.68	$247.41
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $111.36 / $128.97 / $212.21	Professional	TC	$111.36	$128.97	$212.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $83.28 / $114.16 / $222.73	Professional		$83.28	$114.16	$222.73
United Facility/Professional Professional Modifier Low / Median / High Price $188.79 / $228.40 / $318.12	Professional		$188.79	$228.40	$318.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.81 / $93.86 / $144.29	Professional	26	$78.81	$93.86	$144.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.11 / $127.43 / $206.67	Professional	TC	$103.11	$127.43	$206.67