Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.53 / $129.53 / $136.00	Facility	26	$129.53	$129.53	$136.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $327.96 / $475.00 / $696.20	Professional		$327.96	$475.00	$696.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.28 / $140.00 / $412.00	Professional	26	$101.28	$140.00	$412.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $222.00 / $335.00 / $422.10	Professional	TC	$222.00	$335.00	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $266.91 / $267.52 / $273.91	Professional		$266.91	$267.52	$273.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.64 / $142.49 / $163.00	Professional	26	$84.64	$142.49	$163.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.34 / $427.27 / $576.62	Professional		$162.34	$427.27	$576.62
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $173.63 / $173.63 / $173.63	Professional	26	$173.63	$173.63	$173.63
CareSource Facility/Professional Professional Modifier Low / Median / High Price $116.37 / $274.05 / $442.74	Professional		$116.37	$274.05	$442.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.62 / $124.62 / $124.62	Facility	26	$124.62	$124.62	$124.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $350.84 / $538.20 / $857.60	Professional		$350.84	$538.20	$857.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.06 / $135.36 / $268.76	Professional	26	$85.06	$135.36	$268.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.63 / $363.47 / $695.41	Professional	TC	$234.63	$363.47	$695.41
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $91.50 / $129.53 / $133.40	Facility	26	$91.50	$129.53	$133.40
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $312.12 / $408.01 / $615.62	Professional		$312.12	$408.01	$615.62
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $91.50 / $129.53 / $389.19	Professional	26	$91.50	$129.53	$389.19
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $220.61 / $278.48 / $428.43	Professional	TC	$220.61	$278.48	$428.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.51 / $230.37 / $378.52	Professional		$93.51	$230.37	$378.52
United Facility/Professional Professional Modifier Low / Median / High Price $344.74 / $630.19 / $1,087.36	Professional		$344.74	$630.19	$1,087.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.91 / $105.10 / $145.26	Professional	26	$77.91	$105.10	$145.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $261.93 / $539.28 / $910.20	Professional	TC	$261.93	$539.28	$910.20