Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.73 / $70.73 / $74.27	Facility	26	$70.73	$70.73	$74.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $137.58 / $151.90 / $412.74	Professional		$137.58	$151.90	$412.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.67 / $70.73 / $609.50	Professional	26	$53.67	$70.73	$609.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.93 / $83.90 / $124.37	Professional	TC	$71.93	$83.90	$124.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.71 / $115.71 / $135.31	Professional		$115.71	$115.71	$135.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.00 / $77.52 / $85.92	Professional	26	$54.00	$77.52	$85.92
BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.55 / $220.17 / $297.23	Professional		$108.55	$220.17	$297.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.89 / $98.89 / $98.89	Professional	26	$98.89	$98.89	$98.89
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $136.59 / $136.59 / $136.59	Professional	TC	$136.59	$136.59	$136.59
CareSource Facility/Professional Professional Modifier Low / Median / High Price $75.91 / $96.16 / $190.20	Professional		$75.91	$96.16	$190.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.79 / $204.81 / $318.97	Professional		$113.79	$204.81	$318.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.12 / $85.30 / $134.46	Professional	26	$52.12	$85.30	$134.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.06 / $108.04 / $191.91	Professional	TC	$60.06	$108.04	$191.91
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $48.09 / $70.73 / $73.62	Facility	26	$48.09	$70.73	$73.62
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $116.58 / $142.68 / $265.64	Professional		$116.58	$142.68	$265.64
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $48.09 / $70.73 / $419.96	Professional	26	$48.09	$70.73	$419.96
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $68.48 / $75.53 / $119.42	Professional	TC	$68.48	$75.53	$119.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $55.76 / $73.79 / $143.46	Professional		$55.76	$73.79	$143.46
United Facility/Professional Professional Modifier Low / Median / High Price $129.37 / $163.44 / $232.61	Professional		$129.37	$163.44	$232.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.29 / $71.06 / $95.78	Professional	26	$56.29	$71.06	$95.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.48 / $89.95 / $143.04	Professional	TC	$67.48	$89.95	$143.04