Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.75 / $55.75 / $58.53	Facility	26	$55.75	$55.75	$58.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.59 / $179.55 / $373.04	Professional		$147.59	$179.55	$373.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.89 / $55.75 / $135.27	Professional	26	$42.89	$55.75	$135.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.84 / $123.80 / $210.32	Professional	TC	$98.84	$123.80	$210.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.28 / $130.44 / $153.86	Professional		$112.28	$130.44	$153.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.43 / $60.00 / $70.50	Professional	26	$35.43	$60.00	$70.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $145.29 / $145.29 / $145.29	Professional	TC	$145.29	$145.29	$145.29
BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $201.07 / $319.33	Professional		$73.20	$201.07	$319.33
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.56 / $74.56 / $74.56	Professional	26	$74.56	$74.56	$74.56
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $151.66 / $151.66 / $178.42	Professional	TC	$151.66	$151.66	$178.42
CareSource Facility/Professional Professional Modifier Low / Median / High Price $50.27 / $128.44 / $202.11	Professional		$50.27	$128.44	$202.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.63 / $207.89 / $350.82	Professional		$134.63	$207.89	$350.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.04 / $59.23 / $117.12	Professional	26	$37.04	$59.23	$117.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.47 / $148.69 / $256.58	Professional	TC	$96.47	$148.69	$256.58
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $37.64 / $55.75 / $58.53	Facility	26	$37.64	$55.75	$58.53
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $127.66 / $179.55 / $295.00	Professional		$127.66	$179.55	$295.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $37.64 / $55.75 / $108.24	Professional	26	$37.64	$55.75	$108.24
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $90.03 / $123.79 / $207.18	Professional	TC	$90.03	$123.79	$207.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $116.67 / $192.46	Professional		$34.95	$116.67	$192.46
United Facility/Professional Professional Modifier Low / Median / High Price $153.82 / $186.05 / $258.41	Professional		$153.82	$186.05	$258.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.59 / $56.38 / $80.16	Professional	26	$44.59	$56.38	$80.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.26 / $128.63 / $184.71	Professional	TC	$104.26	$128.63	$184.71