Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $476.61 / $2,056.00 / $4,933.00	Facility		$476.61	$2,056.00	$4,933.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $159.82 / $159.82 / $201.37	Facility	26	$159.82	$159.82	$201.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $327.50 / $469.82 / $678.69	Professional		$327.50	$469.82	$678.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.12 / $159.81 / $283.87	Professional	26	$122.12	$159.81	$283.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $205.37 / $273.86 / $406.52	Professional	TC	$205.37	$273.86	$406.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $351.90 / $403.81 / $592.72	Professional		$351.90	$403.81	$592.72
BCBS Facility/Professional Facility Modifier Low / Median / High Price $369.45 / $432.77 / $583.41	Facility		$369.45	$432.77	$583.41
BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.09 / $350.08 / $573.08	Professional		$91.09	$350.08	$573.08
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $198.66 / $198.66 / $198.66	Professional	26	$198.66	$198.66	$198.66
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $318.26 / $374.42 / $374.42	Professional	TC	$318.26	$374.42	$374.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $345.82 / $404.67 / $802.42	Professional		$345.82	$404.67	$802.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.00 / $144.53 / $258.36	Professional	26	$116.00	$144.53	$258.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $207.54 / $291.89 / $544.07	Professional	TC	$207.54	$291.89	$544.07
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $401.43 / $1,638.29 / $2,636.71	Facility		$401.43	$1,638.29	$2,636.71
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $128.40 / $128.40 / $201.37	Facility	26	$128.40	$128.40	$201.37
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $336.18 / $439.90 / $678.69	Professional		$336.18	$439.90	$678.69
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $127.15 / $159.81 / $271.50	Professional	26	$127.15	$159.81	$271.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $207.77 / $270.10 / $418.16	Professional	TC	$207.77	$270.10	$418.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $126.41 / $238.35 / $426.97	Professional		$126.41	$238.35	$426.97
United Facility/Professional Facility Modifier Low / Median / High Price $773.00 / $3,005.00 / $4,504.00	Facility		$773.00	$3,005.00	$4,504.00
United Facility/Professional Professional Modifier Low / Median / High Price $375.13 / $444.77 / $616.13	Professional		$375.13	$444.77	$616.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $144.07 / $173.65 / $216.66	Professional	26	$144.07	$173.65	$216.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $225.90 / $269.58 / $402.97	Professional	TC	$225.90	$269.58	$402.97