Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.85 / $82.85 / $87.00	Facility	26	$82.85	$82.85	$87.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $285.72 / $475.00 / $655.50	Professional		$285.72	$475.00	$655.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.18 / $140.00 / $217.50	Professional	26	$67.18	$140.00	$217.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $242.77 / $335.00 / $441.00	Professional	TC	$242.77	$335.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $226.14 / $295.02 / $295.02	Professional		$226.14	$295.02	$295.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.33 / $63.65 / $91.02	Professional	26	$48.33	$63.65	$91.02
BCBS Facility/Professional Professional Modifier Low / Median / High Price $101.07 / $487.86 / $1,014.75	Professional		$101.07	$487.86	$1,014.75
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.73 / $101.73 / $101.73	Professional	26	$101.73	$101.73	$101.73
CareSource Facility/Professional Professional Modifier Low / Median / High Price $68.45 / $269.75 / $388.20	Professional		$68.45	$269.75	$388.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $300.41 / $541.62 / $930.47	Professional		$300.41	$541.62	$930.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.01 / $78.04 / $158.09	Professional	26	$49.01	$78.04	$158.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $238.13 / $433.92 / $744.90	Professional	TC	$238.13	$433.92	$744.90
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $52.47 / $82.85 / $87.00	Facility	26	$52.47	$82.85	$87.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $343.79 / $384.39 / $655.50	Professional		$343.79	$384.39	$655.50
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $52.47 / $82.86 / $176.40	Professional	26	$52.47	$82.86	$176.40
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $277.20 / $320.68 / $462.57	Professional	TC	$277.20	$320.68	$462.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.71 / $226.14 / $343.14	Professional		$61.71	$226.14	$343.14
United Facility/Professional Professional Modifier Low / Median / High Price $329.09 / $419.00 / $701.22	Professional		$329.09	$419.00	$701.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.00 / $70.36 / $103.94	Professional	26	$60.00	$70.36	$103.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.73 / $345.50 / $514.57	Professional	TC	$251.73	$345.50	$514.57