Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.01 / $90.01 / $113.42	Facility	26	$90.01	$90.01	$113.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.43 / $237.28 / $596.39	Professional		$190.43	$237.28	$596.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.34 / $90.02 / $321.30	Professional	26	$68.34	$90.02	$321.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $118.17 / $147.27 / $226.42	Professional	TC	$118.17	$147.27	$226.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $176.68 / $176.68 / $176.68	Professional		$176.68	$176.68	$176.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.42 / $86.03 / $96.11	Professional	26	$79.42	$86.03	$96.11
BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.60 / $257.72 / $367.73	Professional		$100.60	$257.72	$367.73
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.59 / $107.59 / $107.59	Professional	26	$107.59	$107.59	$107.59
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.63 / $132.26 / $223.74	Professional		$72.63	$132.26	$223.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.55 / $248.44 / $581.29	Professional		$175.55	$248.44	$581.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.15 / $95.83 / $198.88	Professional	26	$70.15	$95.83	$198.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.22 / $162.71 / $384.61	Professional	TC	$100.22	$162.71	$384.61
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $71.26 / $90.01 / $113.42	Facility	26	$71.26	$90.01	$113.42
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $197.66 / $236.58 / $368.62	Professional		$197.66	$236.58	$368.62
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $68.34 / $90.01 / $302.83	Professional	26	$68.34	$90.01	$302.83
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $122.19 / $147.27 / $214.53	Professional	TC	$122.19	$147.27	$214.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.90 / $105.24 / $192.86	Professional		$61.90	$105.24	$192.86
United Facility/Professional Professional Modifier Low / Median / High Price $183.77 / $244.94 / $333.25	Professional		$183.77	$244.94	$333.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.33 / $88.76 / $130.68	Professional	26	$71.33	$88.76	$130.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.36 / $154.65 / $211.12	Professional	TC	$110.36	$154.65	$211.12