Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $130.83 / $130.83 / $155.29	Facility	26	$130.83	$130.83	$155.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $374.65 / $475.00 / $688.75	Professional		$374.65	$475.00	$688.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.94 / $140.00 / $477.84	Professional	26	$105.94	$140.00	$477.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $256.50 / $335.00 / $462.42	Professional	TC	$256.50	$335.00	$462.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.14 / $204.14 / $264.00	Professional		$204.14	$204.14	$264.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.92 / $100.98 / $192.44	Professional	26	$78.92	$100.98	$192.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.38 / $434.44 / $616.10	Professional		$151.38	$434.44	$616.10
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $161.91 / $161.91 / $161.91	Professional	26	$161.91	$161.91	$161.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $108.55 / $278.66 / $438.20	Professional		$108.55	$278.66	$438.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $395.38 / $735.62 / $1,228.28	Professional		$395.38	$735.62	$1,228.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.38 / $124.02 / $249.54	Professional	26	$76.38	$124.02	$249.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $280.30 / $509.02 / $1,041.68	Professional	TC	$280.30	$509.02	$1,041.68
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $83.38 / $130.83 / $155.29	Facility	26	$83.38	$130.83	$155.29
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $385.17 / $515.99 / $763.69	Professional		$385.17	$515.99	$763.69
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $83.38 / $138.93 / $462.00	Professional	26	$83.38	$138.93	$462.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $280.29 / $368.50 / $540.77	Professional	TC	$280.29	$368.50	$540.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.51 / $230.23 / $378.52	Professional		$93.51	$230.23	$378.52
United Facility/Professional Professional Modifier Low / Median / High Price $368.85 / $552.71 / $1,026.13	Professional		$368.85	$552.71	$1,026.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.35 / $112.17 / $177.36	Professional	26	$95.35	$112.17	$177.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $271.88 / $400.67 / $851.84	Professional	TC	$271.88	$400.67	$851.84