Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $151.59 / $159.18 / $191.01	Facility	26	$151.59	$159.18	$191.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.66 / $243.16 / $377.51	Professional		$206.66	$243.16	$377.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.34 / $138.21 / $202.74	Professional	26	$120.34	$138.21	$202.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $617.00 / $617.00 / $617.00	Professional	50	$617.00	$617.00	$617.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.01 / $92.39 / $137.05	Professional	TC	$79.01	$92.39	$137.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $202.68 / $202.68 / $323.44	Professional		$202.68	$202.68	$323.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $117.97 / $133.47 / $189.29	Professional	26	$117.97	$133.47	$189.29
BCBS Facility/Professional Professional Modifier Low / Median / High Price $118.03 / $259.50 / $356.78	Professional		$118.03	$259.50	$356.78
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $205.58 / $205.58 / $205.58	Professional	26	$205.58	$205.58	$205.58
CareSource Facility/Professional Professional Modifier Low / Median / High Price $81.12 / $153.55 / $263.39	Professional		$81.12	$153.55	$263.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $183.99 / $339.95 / $897.77	Professional		$183.99	$339.95	$897.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.66 / $198.37 / $549.60	Professional	26	$112.66	$198.37	$549.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.75 / $131.84 / $348.17	Professional	TC	$74.75	$131.84	$348.17
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $128.47 / $151.59 / $191.01	Facility	26	$128.47	$151.59	$191.01
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $212.72 / $243.17 / $359.03	Professional		$212.72	$243.17	$359.03
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $123.45 / $151.59 / $227.56	Professional	26	$123.45	$151.59	$227.56
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $617.00 / $617.00 / $617.00	Professional	50	$617.00	$617.00	$617.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $83.90 / $91.57 / $128.88	Professional	TC	$83.90	$91.57	$128.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.91 / $137.12 / $267.82	Professional		$60.91	$137.12	$267.82
United Facility/Professional Professional Modifier Low / Median / High Price $222.51 / $257.64 / $372.73	Professional		$222.51	$257.64	$372.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $129.44 / $151.25 / $220.97	Professional	26	$129.44	$151.25	$220.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.98 / $103.96 / $151.28	Professional	TC	$87.98	$103.96	$151.28