Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.65 / $90.65 / $95.19	Facility	26	$90.65	$90.65	$95.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $224.36 / $340.67 / $630.00	Professional		$224.36	$340.67	$630.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.29 / $140.00 / $416.99	Professional	26	$72.29	$140.00	$416.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $135.04 / $199.66 / $422.10	Professional	TC	$135.04	$199.66	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $160.01 / $160.01 / $188.25	Professional		$160.01	$160.01	$188.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.09 / $66.44 / $93.33	Professional	26	$54.09	$66.44	$93.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $119.68 / $289.33 / $390.60	Professional		$119.68	$289.33	$390.60
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $111.31 / $111.31 / $111.31	Professional	26	$111.31	$111.31	$111.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.84 / $142.61 / $241.20	Professional		$74.84	$142.61	$241.20
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 $202.15 / $412.51 / $782.16	Professional		$202.15	$412.51	$782.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.86 / $91.06 / $174.14	Professional	26	$53.86	$91.06	$174.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $137.74 / $262.57 / $559.38	Professional	TC	$137.74	$262.57	$559.38
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $62.87 / $90.65 / $95.19	Facility	26	$62.87	$90.65	$95.19
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $225.90 / $340.67 / $603.00	Professional		$225.90	$340.67	$603.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $62.87 / $93.50 / $389.19	Professional	26	$62.87	$93.50	$389.19
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $143.34 / $214.14 / $385.63	Professional	TC	$143.34	$214.14	$385.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.71 / $128.53 / $192.86	Professional		$61.71	$128.53	$192.86
United Facility/Professional Professional Modifier Low / Median / High Price $205.33 / $267.69 / $573.25	Professional		$205.33	$267.69	$573.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.31 / $82.73 / $122.86	Professional	26	$70.31	$82.73	$122.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.70 / $175.71 / $496.04	Professional	TC	$122.70	$175.71	$496.04