Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.64 / $44.64 / $56.25	Facility	26	$44.64	$44.64	$56.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $161.84 / $219.03 / $413.13	Professional		$161.84	$219.03	$413.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.00 / $57.14 / $186.40	Professional	26	$39.00	$57.14	$186.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.45 / $162.12 / $305.80	Professional	TC	$113.45	$162.12	$305.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.25 / $122.36 / $142.75	Professional		$117.25	$122.36	$142.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.00 / $37.11 / $114.36	Professional	26	$28.00	$37.11	$114.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $83.43 / $83.43 / $83.43	Professional	TC	$83.43	$83.43	$83.43
BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.77 / $206.74 / $294.44	Professional		$55.77	$206.74	$294.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $40.09 / $137.44 / $191.82	Professional		$40.09	$137.44	$191.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.24 / $43.24 / $43.24	Facility	26	$43.24	$43.24	$43.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.65 / $212.64 / $438.03	Professional		$145.65	$212.64	$438.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.40 / $57.51 / $109.84	Professional	26	$37.40	$57.51	$109.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.46 / $161.41 / $324.23	Professional	TC	$111.46	$161.41	$324.23
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $44.64 / $45.45 / $58.94	Facility	26	$44.64	$45.45	$58.94
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $161.84 / $212.05 / $362.86	Professional		$161.84	$212.05	$362.86
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $40.25 / $58.94 / $173.30	Professional	26	$40.25	$58.94	$173.30
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $116.64 / $153.11 / $250.91	Professional	TC	$116.64	$153.11	$250.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $123.06 / $202.16	Professional		$36.43	$123.06	$202.16
United Facility/Professional Professional Modifier Low / Median / High Price $167.46 / $213.92 / $296.04	Professional		$167.46	$213.92	$296.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.92 / $59.42 / $77.84	Professional	26	$39.92	$59.42	$77.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $126.26 / $156.51 / $217.00	Professional	TC	$126.26	$156.51	$217.00