Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.71 / $55.71 / $70.20	Facility	26	$55.71	$55.71	$70.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.46 / $142.88 / $489.55	Professional		$117.46	$142.88	$489.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $55.72 / $172.85	Professional	26	$42.60	$55.72	$172.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.63 / $83.30 / $156.18	Professional	TC	$64.63	$83.30	$156.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.89 / $113.04 / $179.04	Professional		$84.89	$113.04	$179.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.90 / $57.68 / $83.05	Professional	26	$36.90	$57.68	$83.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.02 / $61.67 / $120.40	Professional	TC	$57.02	$61.67	$120.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.70 / $140.49 / $193.32	Professional		$69.70	$140.49	$193.32
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.38 / $74.56 / $74.56	Professional	26	$63.38	$74.56	$74.56
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.61 / $111.31 / $111.31	Professional	TC	$94.61	$111.31	$111.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $50.24 / $80.12 / $137.96	Professional		$50.24	$80.12	$137.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.79 / $150.03 / $320.83	Professional		$99.79	$150.03	$320.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.75 / $57.62 / $135.90	Professional	26	$37.75	$57.62	$135.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.87 / $88.85 / $203.62	Professional	TC	$55.87	$88.85	$203.62
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $38.17 / $55.71 / $70.20	Facility	26	$38.17	$55.71	$70.20
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $103.21 / $136.38 / $270.58	Professional		$103.21	$136.38	$270.58
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $38.17 / $55.71 / $104.47	Professional	26	$38.17	$55.71	$104.47
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $65.04 / $79.34 / $127.14	Professional	TC	$65.04	$79.34	$127.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.56 / $79.45 / $123.28	Professional		$36.56	$79.45	$123.28
United Facility/Professional Professional Modifier Low / Median / High Price $109.96 / $134.75 / $188.81	Professional		$109.96	$134.75	$188.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.22 / $53.21 / $72.23	Professional	26	$43.22	$53.21	$72.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.39 / $81.98 / $110.85	Professional	TC	$67.39	$81.98	$110.85