Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.39 / $45.39 / $57.20	Facility	26	$45.39	$45.39	$57.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.04 / $127.86 / $214.31	Professional		$101.04	$127.86	$214.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $45.39 / $88.29	Professional	26	$29.91	$45.39	$88.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.14 / $94.59 / $153.41	Professional	TC	$71.14	$94.59	$153.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.98 / $89.98 / $89.98	Professional		$89.98	$89.98	$89.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.36 / $35.79 / $65.43	Professional	26	$28.36	$35.79	$65.43
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.77 / $148.19 / $192.89	Professional		$56.77	$148.19	$192.89
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.61 / $60.72 / $60.72	Professional	26	$51.61	$60.72	$60.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $40.77 / $95.06 / $154.07	Professional		$40.77	$95.06	$154.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.17 / $149.08 / $259.52	Professional		$98.17	$149.08	$259.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.04 / $45.97 / $86.25	Professional	26	$27.04	$45.97	$86.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.87 / $100.39 / $185.38	Professional	TC	$62.87	$100.39	$185.38
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $27.26 / $45.39 / $47.67	Facility	26	$27.26	$45.39	$47.67
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $91.78 / $138.03 / $212.67	Professional		$91.78	$138.03	$212.67
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $27.26 / $45.30 / $79.79	Professional	26	$27.26	$45.30	$79.79
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $64.51 / $95.62 / $146.31	Professional	TC	$64.51	$95.62	$146.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $78.16 / $152.74	Professional		$34.95	$78.16	$152.74
United Facility/Professional Professional Modifier Low / Median / High Price $96.89 / $118.83 / $175.14	Professional		$96.89	$118.83	$175.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.96 / $39.43 / $57.36	Professional	26	$31.96	$39.43	$57.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.93 / $79.37 / $119.36	Professional	TC	$64.93	$79.37	$119.36