Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $143.91 / $143.91 / $181.33	Facility	26	$143.91	$143.91	$181.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $284.20 / $414.14 / $515.60	Professional		$284.20	$414.14	$515.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.37 / $123.52 / $345.97	Professional	26	$104.37	$123.52	$345.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $172.14 / $309.76 / $385.70	Professional	TC	$172.14	$309.76	$385.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $286.81 / $286.81 / $310.35	Professional		$286.81	$286.81	$310.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $86.74 / $110.92 / $159.65	Professional	26	$86.74	$110.92	$159.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $166.33 / $547.97 / $685.27	Professional		$166.33	$547.97	$685.27
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $177.89 / $177.89 / $177.89	Professional	26	$177.89	$177.89	$177.89
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $488.39 / $488.39 / $488.39	Professional	TC	$488.39	$488.39	$488.39
CareSource Facility/Professional Professional Modifier Low / Median / High Price $119.40 / $351.49 / $531.20	Professional		$119.40	$351.49	$531.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $325.07 / $639.83 / $997.92	Professional		$325.07	$639.83	$997.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.12 / $135.15 / $276.45	Professional	26	$84.12	$135.15	$276.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $224.11 / $461.17 / $843.74	Professional	TC	$224.11	$461.17	$843.74
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $93.43 / $143.91 / $172.60	Facility	26	$93.43	$143.91	$172.60
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $320.07 / $393.88 / $619.03	Professional		$320.07	$393.88	$619.03
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $93.43 / $142.84 / $345.97	Professional	26	$93.43	$142.84	$345.97
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $211.06 / $300.44 / $460.32	Professional	TC	$211.06	$300.44	$460.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.51 / $169.43 / $297.67	Professional		$93.51	$169.43	$297.67
United Facility/Professional Professional Modifier Low / Median / High Price $398.07 / $544.79 / $778.44	Professional		$398.07	$544.79	$778.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.33 / $126.24 / $197.14	Professional	26	$106.33	$126.24	$197.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $291.83 / $373.90 / $603.38	Professional	TC	$291.83	$373.90	$603.38