Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.37 / $89.37 / $105.54	Facility	26	$89.37	$89.37	$105.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.15 / $397.68 / $630.00	Professional		$221.15	$397.68	$630.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.75 / $140.00 / $317.45	Professional	26	$73.75	$140.00	$317.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $150.30 / $249.00 / $441.00	Professional	TC	$150.30	$249.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $118.12 / $118.12 / $118.12	Professional		$118.12	$118.12	$118.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.45 / $67.84 / $136.58	Professional	26	$55.45	$67.84	$136.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.29 / $233.05 / $329.58	Professional		$112.29	$233.05	$329.58
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.18 / $109.18 / $109.18	Professional	26	$109.18	$109.18	$109.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $73.40 / $149.50 / $252.83	Professional		$73.40	$149.50	$252.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $241.08 / $427.16 / $785.09	Professional		$241.08	$427.16	$785.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.70 / $84.86 / $171.71	Professional	26	$52.70	$84.86	$171.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.77 / $297.50 / $518.29	Professional	TC	$162.77	$297.50	$518.29
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $56.91 / $89.37 / $93.84	Facility	26	$56.91	$89.37	$93.84
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $226.65 / $335.51 / $598.50	Professional		$226.65	$335.51	$598.50
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $56.91 / $93.86 / $296.76	Professional	26	$56.91	$93.86	$296.76
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $150.30 / $278.60 / $422.10	Professional	TC	$150.30	$278.60	$422.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.71 / $128.53 / $192.86	Professional		$61.71	$128.53	$192.86
United Facility/Professional Professional Modifier Low / Median / High Price $221.66 / $384.60 / $545.47	Professional		$221.66	$384.60	$545.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.01 / $76.48 / $120.55	Professional	26	$65.01	$76.48	$120.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $139.72 / $289.68 / $449.77	Professional	TC	$139.72	$289.68	$449.77