Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.32 / $109.32 / $114.78	Facility	26	$109.32	$109.32	$114.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $347.69 / $475.00 / $638.00	Professional		$347.69	$475.00	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.20 / $128.78 / $199.08	Professional	26	$85.20	$128.78	$199.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.99 / $335.00 / $488.08	Professional	TC	$259.99	$335.00	$488.08
BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.99 / $414.02 / $615.50	Professional		$125.99	$414.02	$615.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $367.53 / $594.16 / $984.50	Professional		$367.53	$594.16	$984.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.88 / $103.09 / $208.14	Professional	26	$63.88	$103.09	$208.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $268.20 / $462.90 / $765.20	Professional	TC	$268.20	$462.90	$765.20
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $70.01 / $70.01 / $109.32	Facility	26	$70.01	$70.01	$109.32
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $370.11 / $432.28 / $661.50	Professional		$370.11	$432.28	$661.50
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $70.01 / $109.32 / $162.32	Professional	26	$70.01	$109.32	$162.32
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $275.16 / $338.41 / $588.76	Professional	TC	$275.16	$338.41	$588.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.51 / $256.90 / $384.92	Professional		$93.51	$256.90	$384.92
United Facility/Professional Professional Modifier Low / Median / High Price $353.13 / $473.66 / $687.66	Professional		$353.13	$473.66	$687.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $94.87 / $147.84	Professional	26	$79.43	$94.87	$147.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $289.50 / $414.10 / $575.44	Professional	TC	$289.50	$414.10	$575.44