Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $133.84 / $133.84 / $142.80	Facility	26	$133.84	$133.84	$142.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $372.85 / $475.00 / $903.45	Professional		$372.85	$475.00	$903.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.75 / $140.00 / $451.25	Professional	26	$105.75	$140.00	$451.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $262.73 / $335.00 / $524.94	Professional	TC	$262.73	$335.00	$524.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $178.18 / $262.95 / $331.35	Professional		$178.18	$262.95	$331.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.70 / $126.76 / $210.27	Professional	26	$80.70	$126.76	$210.27
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $165.04 / $165.04 / $165.04	Professional	TC	$165.04	$165.04	$165.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.87 / $407.94 / $611.91	Professional		$154.87	$407.94	$611.91
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $140.79 / $165.64 / $165.64	Professional	26	$140.79	$165.64	$165.64
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $379.74 / $379.74 / $379.74	Professional	TC	$379.74	$379.74	$379.74
CareSource Facility/Professional Professional Modifier Low / Median / High Price $111.10 / $273.29 / $435.44	Professional		$111.10	$273.29	$435.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $393.19 / $733.43 / $1,247.66	Professional		$393.19	$733.43	$1,247.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.34 / $127.77 / $255.24	Professional	26	$78.34	$127.77	$255.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $279.61 / $504.00 / $1,045.65	Professional	TC	$279.61	$504.00	$1,045.65
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $87.61 / $133.84 / $142.80	Facility	26	$87.61	$133.84	$142.80
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $397.62 / $522.79 / $903.45	Professional		$397.62	$522.79	$903.45
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $87.61 / $140.00 / $396.00	Professional	26	$87.61	$140.00	$396.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $274.87 / $368.50 / $575.29	Professional	TC	$274.87	$368.50	$575.29
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 $366.14 / $585.58 / $1,080.07	Professional		$366.14	$585.58	$1,080.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.98 / $117.96 / $187.18	Professional	26	$99.98	$117.96	$187.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $256.27 / $459.26 / $850.32	Professional	TC	$256.27	$459.26	$850.32