Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.18 / $122.18 / $128.28	Facility	26	$122.18	$122.18	$128.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $350.05 / $436.57 / $661.73	Professional		$350.05	$436.57	$661.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.53 / $122.18 / $284.45	Professional	26	$84.53	$122.18	$284.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $253.50 / $314.38 / $499.76	Professional	TC	$253.50	$314.38	$499.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $255.19 / $332.37 / $332.37	Professional		$255.19	$332.37	$332.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $76.52 / $121.85 / $186.14	Professional	26	$76.52	$121.85	$186.14
BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.97 / $445.79 / $569.97	Professional		$147.97	$445.79	$569.97
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $128.12 / $150.72 / $150.72	Professional	26	$128.12	$150.72	$150.72
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $397.32 / $397.32 / $397.32	Professional	TC	$397.32	$397.32	$397.32
CareSource Facility/Professional Professional Modifier Low / Median / High Price $101.27 / $285.94 / $437.27	Professional		$101.27	$285.94	$437.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.46 / $108.46 / $108.46	Facility	26	$108.46	$108.46	$108.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $321.01 / $507.59 / $831.99	Professional		$321.01	$507.59	$831.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.59 / $114.49 / $234.02	Professional	26	$74.59	$114.49	$234.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $219.52 / $376.64 / $682.47	Professional	TC	$219.52	$376.64	$682.47
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $77.56 / $122.18 / $128.28	Facility	26	$77.56	$122.18	$128.28
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $355.89 / $436.56 / $661.73	Professional		$355.89	$436.56	$661.73
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $77.56 / $118.21 / $233.00	Professional	26	$77.56	$118.21	$233.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $278.33 / $314.38 / $471.57	Professional	TC	$278.33	$314.38	$471.57
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 $344.06 / $419.49 / $588.32	Professional		$344.06	$419.49	$588.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $90.23 / $110.04 / $166.30	Professional	26	$90.23	$110.04	$166.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $244.21 / $312.08 / $476.00	Professional	TC	$244.21	$312.08	$476.00