Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.69 / $190.78 / $228.94	Facility	26	$181.69	$190.78	$228.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $236.09 / $274.20 / $459.17	Professional		$236.09	$274.20	$459.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $144.25 / $165.65 / $242.34	Professional	26	$144.25	$165.65	$242.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.31 / $104.53 / $152.46	Professional	TC	$88.31	$104.53	$152.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $166.03 / $236.75 / $307.77	Professional		$166.03	$236.75	$307.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $135.12 / $197.70 / $218.82	Professional	26	$135.12	$197.70	$218.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.47 / $276.08 / $415.77	Professional		$131.47	$276.08	$415.77
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $246.06 / $246.06 / $246.06	Professional	26	$246.06	$246.06	$246.06
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $140.61 / $140.61 / $140.61	Professional	TC	$140.61	$140.61	$140.61
CareSource Facility/Professional Professional Modifier Low / Median / High Price $90.22 / $179.40 / $307.45	Professional		$90.22	$179.40	$307.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $214.41 / $384.62 / $1,044.52	Professional		$214.41	$384.62	$1,044.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $237.93 / $657.50	Professional	26	$134.90	$237.93	$657.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.20 / $146.55 / $387.02	Professional	TC	$84.20	$146.55	$387.02
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $154.13 / $181.69 / $228.94	Facility	26	$154.13	$181.69	$228.94
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $248.78 / $284.81 / $442.21	Professional		$248.78	$284.81	$442.21
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $147.96 / $181.69 / $258.08	Professional	26	$147.96	$181.69	$258.08
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $93.55 / $103.12 / $141.32	Professional	TC	$93.55	$103.12	$141.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $91.22 / $143.90 / $270.82	Professional		$91.22	$143.90	$270.82
United Facility/Professional Professional Modifier Low / Median / High Price $257.54 / $299.12 / $436.84	Professional		$257.54	$299.12	$436.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $155.66 / $180.24 / $261.60	Professional	26	$155.66	$180.24	$261.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.08 / $116.41 / $159.22	Professional	TC	$99.08	$116.41	$159.22