Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.23 / $99.23 / $104.20	Facility	26	$99.23	$99.23	$104.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $322.37 / $475.00 / $642.44	Professional		$322.37	$475.00	$642.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.34 / $140.00 / $268.30	Professional	26	$79.34	$140.00	$268.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $248.88 / $335.00 / $450.05	Professional	TC	$248.88	$335.00	$450.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $222.56 / $241.38 / $241.38	Professional		$222.56	$241.38	$241.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.94 / $76.33 / $109.11	Professional	26	$57.94	$76.33	$109.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $165.74 / $165.74 / $165.74	Professional	TC	$165.74	$165.74	$165.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $142.55 / $470.59 / $988.25	Professional		$142.55	$470.59	$988.25
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.67 / $121.97 / $121.97	Professional	26	$103.67	$121.97	$121.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $82.10 / $272.25 / $401.16	Professional		$82.10	$272.25	$401.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.30 / $88.30 / $88.30	Facility	26	$88.30	$88.30	$88.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.34 / $580.62 / $937.43	Professional		$346.34	$580.62	$937.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.17 / $93.96 / $191.47	Professional	26	$59.17	$93.96	$191.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $262.99 / $443.06 / $779.10	Professional	TC	$262.99	$443.06	$779.10
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $63.67 / $99.23 / $104.20	Facility	26	$63.67	$99.23	$104.20
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $339.20 / $401.58 / $642.44	Professional		$339.20	$401.58	$642.44
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $63.67 / $101.22 / $225.47	Professional	26	$63.67	$101.22	$225.47
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $276.04 / $322.52 / $485.75	Professional	TC	$276.04	$322.52	$485.75
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 $338.04 / $448.63 / $703.78	Professional		$338.04	$448.63	$703.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.36 / $84.76 / $134.43	Professional	26	$74.36	$84.76	$134.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.29 / $353.28 / $550.24	Professional	TC	$257.29	$353.28	$550.24