Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.26 / $90.26 / $94.77	Facility	26	$90.26	$90.26	$94.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.59 / $475.00 / $661.50	Professional		$338.59	$475.00	$661.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.43 / $135.13 / $353.10	Professional	26	$74.43	$135.13	$353.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $267.69 / $335.00 / $500.05	Professional	TC	$267.69	$335.00	$500.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $215.98 / $215.98 / $215.98	Professional		$215.98	$215.98	$215.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.85 / $68.81 / $132.30	Professional	26	$53.85	$68.81	$132.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.72 / $495.49 / $674.96	Professional		$107.72	$495.49	$674.96
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $110.78 / $110.78 / $110.78	Professional	26	$110.78	$110.78	$110.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $68.02 / $288.22 / $410.07	Professional		$68.02	$288.22	$410.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $400.31 / $715.74 / $1,425.50	Professional		$400.31	$715.74	$1,425.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.42 / $99.95 / $202.62	Professional	26	$58.42	$99.95	$202.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $322.22 / $556.27 / $1,010.41	Professional	TC	$322.22	$556.27	$1,010.41
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $70.48 / $90.26 / $94.77	Facility	26	$70.48	$90.26	$94.77
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $378.68 / $522.50 / $775.71	Professional		$378.68	$522.50	$775.71
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $70.48 / $96.33 / $339.90	Professional	26	$70.48	$96.33	$339.90
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $305.77 / $411.73 / $659.61	Professional	TC	$305.77	$411.73	$659.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.71 / $247.45 / $357.10	Professional		$61.71	$247.45	$357.10
United Facility/Professional Professional Modifier Low / Median / High Price $372.63 / $675.74 / $1,016.78	Professional		$372.63	$675.74	$1,016.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.88 / $89.36 / $129.46	Professional	26	$73.88	$89.36	$129.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $295.24 / $567.42 / $875.46	Professional	TC	$295.24	$567.42	$875.46