Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.22 / $45.22 / $56.98	Facility	26	$45.22	$45.22	$56.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.04 / $215.90 / $440.92	Professional		$179.04	$215.90	$440.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.30 / $43.65 / $89.30	Professional	26	$28.30	$43.65	$89.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $145.19 / $170.68 / $336.02	Professional	TC	$145.19	$170.68	$336.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.78 / $154.54 / $236.35	Professional		$121.78	$154.54	$236.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.30 / $35.82 / $53.73	Professional	26	$29.30	$35.82	$53.73
BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.77 / $254.42 / $311.29	Professional		$55.77	$254.42	$311.29
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.70 / $59.65 / $59.65	Professional	26	$50.70	$59.65	$59.65
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $203.72 / $239.67 / $239.67	Professional	TC	$203.72	$239.67	$239.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.76 / $167.23 / $227.27	Professional		$39.76	$167.23	$227.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.27 / $43.27 / $43.27	Facility	26	$43.27	$43.27	$43.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $183.41 / $252.40 / $541.03	Professional		$183.41	$252.40	$541.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.05 / $43.34 / $106.88	Professional	26	$31.05	$43.34	$106.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.54 / $207.20 / $433.15	Professional	TC	$147.54	$207.20	$433.15
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $29.47 / $45.22 / $47.49	Facility	26	$29.47	$45.22	$47.49
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $189.77 / $227.55 / $372.24	Professional		$189.77	$227.55	$372.24
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $29.47 / $45.09 / $77.48	Professional	26	$29.47	$45.09	$77.48
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $158.97 / $198.62 / $282.39	Professional	TC	$158.97	$198.62	$282.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $156.71 / $244.97	Professional		$36.43	$156.71	$244.97
United Facility/Professional Professional Modifier Low / Median / High Price $196.81 / $239.88 / $343.30	Professional		$196.81	$239.88	$343.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.63 / $39.89 / $66.17	Professional	26	$30.63	$39.89	$66.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $161.72 / $197.47 / $303.75	Professional	TC	$161.72	$197.47	$303.75