Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.84 / $93.84 / $93.84	Facility	26	$93.84	$93.84	$93.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.08 / $152.00 / $231.28	Professional		$130.08	$152.00	$231.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.70 / $83.62 / $121.59	Professional	26	$74.70	$83.62	$121.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.39 / $72.81 / $111.09	Professional	TC	$51.39	$72.81	$111.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $135.78 / $135.78 / $135.78	Professional		$135.78	$135.78	$135.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.86 / $77.86 / $96.16	Professional	26	$77.86	$77.86	$96.16
BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.13 / $209.15 / $287.58	Professional		$112.13	$209.15	$287.58
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $126.23 / $126.23 / $126.23	Professional	26	$126.23	$126.23	$126.23
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $119.84 / $119.84 / $119.84	Professional	TC	$119.84	$119.84	$119.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $73.72 / $97.21 / $192.18	Professional		$73.72	$97.21	$192.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.59 / $252.78 / $669.01	Professional		$125.59	$252.78	$669.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.16 / $121.72 / $338.10	Professional	26	$69.16	$121.72	$338.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.96 / $125.30 / $330.91	Professional	TC	$50.96	$125.30	$330.91
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $76.83 / $76.83 / $93.84	Facility	26	$76.83	$76.83	$93.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $130.08 / $160.87 / $234.55	Professional		$130.08	$160.87	$234.55
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $75.04 / $85.67 / $132.36	Professional	26	$75.04	$85.67	$132.36
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $55.03 / $74.95 / $117.79	Professional	TC	$55.03	$74.95	$117.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.28 / $105.49 / $193.27	Professional		$60.28	$105.49	$193.27
United Facility/Professional Professional Modifier Low / Median / High Price $125.37 / $177.13 / $275.72	Professional		$125.37	$177.13	$275.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.28 / $93.81 / $130.87	Professional	26	$77.28	$93.81	$130.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.94 / $89.61 / $139.49	Professional	TC	$38.94	$89.61	$139.49