Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.00 / $57.00 / $57.00	Facility	26	$57.00	$57.00	$57.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $146.03 / $221.37 / $709.48	Professional		$146.03	$221.37	$709.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.91 / $84.06 / $257.12	Professional	26	$53.91	$84.06	$257.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.58 / $137.37 / $452.37	Professional	TC	$91.58	$137.37	$452.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.36 / $115.83 / $127.41	Professional		$108.36	$115.83	$127.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.43 / $51.68 / $64.29	Professional	26	$36.43	$51.68	$64.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $78.14 / $78.14 / $78.14	Professional	TC	$78.14	$78.14	$78.14
BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.72 / $110.55 / $190.76	Professional		$67.72	$110.55	$190.76
CareSource Facility/Professional Professional Modifier Low / Median / High Price $63.48 / $98.12 / $178.10	Professional		$63.48	$98.12	$178.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.98 / $247.01 / $321.89	Professional		$116.98	$247.01	$321.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.29 / $46.62 / $93.73	Professional	26	$44.29	$46.62	$93.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.70 / $117.00 / $153.27	Professional	TC	$72.70	$117.00	$153.27
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $33.35 / $33.35 / $57.00	Facility	26	$33.35	$33.35	$57.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $112.68 / $148.57 / $208.81	Professional		$112.68	$148.57	$208.81
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $33.35 / $50.60 / $71.81	Professional	26	$33.35	$50.60	$71.81
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $79.33 / $91.58 / $160.97	Professional	TC	$79.33	$91.58	$160.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.44 / $75.88 / $147.50	Professional		$34.44	$75.88	$147.50
United Facility/Professional Professional Modifier Low / Median / High Price $114.42 / $151.65 / $204.34	Professional		$114.42	$151.65	$204.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.58 / $45.72 / $63.63	Professional	26	$38.58	$45.72	$63.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.69 / $93.18 / $145.50	Professional	TC	$73.69	$93.18	$145.50