Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.22 / $131.22 / $137.79	Facility	26	$131.22	$131.22	$137.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $348.10 / $475.00 / $876.67	Professional		$348.10	$475.00	$876.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.69 / $140.00 / $405.48	Professional	26	$102.69	$140.00	$405.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $248.84 / $335.00 / $499.00	Professional	TC	$248.84	$335.00	$499.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $202.97 / $254.71 / $254.71	Professional		$202.97	$254.71	$254.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.16 / $101.30 / $193.04	Professional	26	$79.16	$101.30	$193.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.88 / $535.96 / $1,122.96	Professional		$151.88	$535.96	$1,122.96
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $162.44 / $162.44 / $162.44	Professional	26	$162.44	$162.44	$162.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $108.89 / $275.98 / $435.68	Professional		$108.89	$275.98	$435.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $392.13 / $733.85 / $1,241.78	Professional		$392.13	$733.85	$1,241.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.65 / $121.71 / $249.54	Professional	26	$76.65	$121.71	$249.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $276.77 / $508.96 / $1,041.68	Professional	TC	$276.77	$508.96	$1,041.68
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $83.65 / $131.22 / $133.59	Facility	26	$83.65	$131.22	$133.59
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $382.86 / $494.18 / $738.63	Professional		$382.86	$494.18	$738.63
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $83.65 / $131.22 / $396.06	Professional	26	$83.65	$131.22	$396.06
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $276.39 / $368.50 / $575.82	Professional	TC	$276.39	$368.50	$575.82
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 $369.51 / $594.39 / $1,027.04	Professional		$369.51	$594.39	$1,027.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $98.42 / $112.11 / $164.03	Professional	26	$98.42	$112.11	$164.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.20 / $443.41 / $855.34	Professional	TC	$263.20	$443.41	$855.34