Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.87 / $139.87 / $146.87	Facility	26	$139.87	$139.87	$146.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $336.44 / $475.00 / $661.50	Professional		$336.44	$475.00	$661.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.41 / $140.00 / $475.27	Professional	26	$110.41	$140.00	$475.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $222.88 / $335.00 / $433.00	Professional	TC	$222.88	$335.00	$433.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.00 / $314.62 / $316.33	Professional		$257.00	$314.62	$316.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.38 / $108.19 / $155.19	Professional	26	$84.38	$108.19	$155.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $161.85 / $389.02 / $656.14	Professional		$161.85	$389.02	$656.14
CareSource Facility/Professional Professional Modifier Low / Median / High Price $116.00 / $249.54 / $415.37	Professional		$116.00	$249.54	$415.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $345.71 / $686.76 / $1,207.27	Professional		$345.71	$686.76	$1,207.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.10 / $141.90 / $270.72	Professional	26	$85.10	$141.90	$270.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $228.32 / $433.12 / $1,067.46	Professional	TC	$228.32	$433.12	$1,067.46
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $100.86 / $139.87 / $142.38	Facility	26	$100.86	$139.87	$142.38
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $363.07 / $482.40 / $644.54	Professional		$363.07	$482.40	$644.54
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $100.86 / $140.00 / $462.64	Professional	26	$100.86	$140.00	$462.64
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $250.93 / $343.34 / $485.75	Professional	TC	$250.93	$343.34	$485.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.51 / $198.34 / $337.76	Professional		$93.51	$198.34	$337.76
United Facility/Professional Professional Modifier Low / Median / High Price $352.25 / $597.09 / $1,075.90	Professional		$352.25	$597.09	$1,075.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $107.04 / $129.02 / $189.51	Professional	26	$107.04	$129.02	$189.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $232.53 / $305.73 / $808.92	Professional	TC	$232.53	$305.73	$808.92