Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.09 / $56.09 / $70.67	Facility	26	$56.09	$56.09	$70.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.47 / $155.36 / $438.25	Professional		$129.47	$155.36	$438.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $56.09 / $178.04	Professional	26	$42.60	$56.09	$178.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.81 / $99.56 / $187.80	Professional	TC	$83.81	$99.56	$187.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.23 / $118.05 / $219.28	Professional		$95.23	$118.05	$219.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $49.02 / $83.63	Professional	26	$35.65	$49.02	$83.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $77.08 / $77.08 / $150.69	Professional	TC	$77.08	$77.08	$150.69
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.22 / $181.99 / $227.97	Professional		$70.22	$181.99	$227.97
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.84 / $75.09 / $75.09	Professional	26	$63.84	$75.09	$75.09
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $118.16 / $139.01 / $139.01	Professional	TC	$118.16	$139.01	$139.01
CareSource Facility/Professional Professional Modifier Low / Median / High Price $50.58 / $100.09 / $164.09	Professional		$50.58	$100.09	$164.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.96 / $53.96 / $53.96	Facility	26	$53.96	$53.96	$53.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.04 / $167.48 / $364.69	Professional		$114.04	$167.48	$364.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.01 / $58.04 / $136.84	Professional	26	$38.01	$58.04	$136.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.00 / $109.13 / $254.64	Professional	TC	$74.00	$109.13	$254.64
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $38.17 / $56.09 / $70.67	Facility	26	$38.17	$56.09	$70.67
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $119.35 / $155.13 / $277.67	Professional		$119.35	$155.13	$277.67
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $38.17 / $56.09 / $121.71	Professional	26	$38.17	$56.09	$121.71
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $81.18 / $99.05 / $161.24	Professional	TC	$81.18	$99.05	$161.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.56 / $111.83 / $169.81	Professional		$36.56	$111.83	$169.81
United Facility/Professional Professional Modifier Low / Median / High Price $124.82 / $152.91 / $207.35	Professional		$124.82	$152.91	$207.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.23 / $53.45 / $72.72	Professional	26	$43.23	$53.45	$72.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.49 / $99.55 / $142.77	Professional	TC	$82.49	$99.55	$142.77