Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.81 / $125.82 / $158.53	Facility	26	$125.81	$125.82	$158.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.31 / $194.26 / $260.72	Professional		$158.31	$194.26	$260.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.92 / $125.82 / $262.51	Professional	26	$90.92	$125.82	$262.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.07 / $67.28 / $109.05	Professional	TC	$36.07	$67.28	$109.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.35 / $143.82 / $158.19	Professional		$136.35	$143.82	$158.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.82 / $137.84 / $149.30	Professional	26	$84.82	$137.84	$149.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.26 / $208.15 / $295.80	Professional		$58.26	$208.15	$295.80
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $172.03 / $172.03 / $172.03	Professional	26	$172.03	$172.03	$172.03
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $62.31 / $62.31 / $62.31	Professional	TC	$62.31	$62.31	$62.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $49.40 / $150.51 / $232.65	Professional		$49.40	$150.51	$232.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.27 / $215.29 / $364.62	Professional		$129.27	$215.29	$364.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.00 / $155.28 / $238.26	Professional	26	$93.00	$155.28	$238.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.37 / $57.19 / $137.63	Professional	TC	$27.37	$57.19	$137.63
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $81.91 / $125.81 / $128.08	Facility	26	$81.91	$125.81	$128.08
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $137.16 / $161.88 / $243.28	Professional		$137.16	$161.88	$243.28
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $81.91 / $125.81 / $237.35	Professional	26	$81.91	$125.81	$237.35
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $36.07 / $55.25 / $100.62	Professional	TC	$36.07	$55.25	$100.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.82 / $98.87 / $144.99	Professional		$29.82	$98.87	$144.99
United Facility/Professional Professional Modifier Low / Median / High Price $136.78 / $187.10 / $437.40	Professional		$136.78	$187.10	$437.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.45 / $121.88 / $172.85	Professional	26	$95.45	$121.88	$172.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.98 / $59.98 / $259.23	Professional	TC	$25.98	$59.98	$259.23