Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.43 / $108.43 / $113.85	Facility	26	$108.43	$108.43	$113.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $231.66 / $296.69 / $773.72	Professional		$231.66	$296.69	$773.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.76 / $108.43 / $361.00	Professional	26	$80.76	$108.43	$361.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.07 / $188.25 / $279.43	Professional	TC	$151.07	$188.25	$279.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $208.54 / $222.52 / $222.52	Professional		$208.54	$222.52	$222.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $76.77 / $76.77 / $153.54	Professional	26	$76.77	$76.77	$153.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.51 / $325.48 / $428.26	Professional		$120.51	$325.48	$428.26
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $128.88 / $128.88 / $128.88	Professional	26	$128.88	$128.88	$128.88
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $237.54 / $237.54 / $237.54	Professional	TC	$237.54	$237.54	$237.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $87.02 / $171.05 / $281.25	Professional		$87.02	$171.05	$281.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.50 / $326.54 / $722.36	Professional		$218.50	$326.54	$722.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.05 / $119.79 / $250.15	Professional	26	$84.05	$119.79	$250.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.21 / $204.89 / $477.90	Professional	TC	$154.21	$204.89	$477.90
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $85.33 / $108.43 / $110.38	Facility	26	$85.33	$108.43	$110.38
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $235.34 / $296.69 / $472.33	Professional		$235.34	$296.69	$472.33
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $82.48 / $108.43 / $267.20	Professional	26	$82.48	$108.43	$267.20
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $150.01 / $185.64 / $251.61	Professional	TC	$150.01	$185.64	$251.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $94.16 / $145.31 / $271.44	Professional		$94.16	$145.31	$271.44
United Facility/Professional Professional Modifier Low / Median / High Price $238.68 / $300.48 / $407.17	Professional		$238.68	$300.48	$407.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.20 / $106.98 / $154.05	Professional	26	$86.20	$106.98	$154.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.12 / $187.72 / $244.26	Professional	TC	$151.12	$187.72	$244.26