Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.87 / $96.87 / $101.72	Facility	26	$96.87	$96.87	$101.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $481.64 / $540.34 / $841.50	Professional		$481.64	$540.34	$841.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.73 / $96.87 / $186.47	Professional	26	$67.73	$96.87	$186.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $394.43 / $414.31 / $621.46	Professional	TC	$394.43	$414.31	$621.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $394.82 / $424.62 / $424.62	Professional		$394.82	$424.62	$424.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.11 / $105.78 / $117.12	Professional	26	$67.11	$105.78	$117.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.49 / $658.33 / $732.26	Professional		$123.49	$658.33	$732.26
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $132.08 / $132.08 / $132.08	Professional	26	$132.08	$132.08	$132.08
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $572.01 / $572.01 / $572.01	Professional	TC	$572.01	$572.01	$572.01
CareSource Facility/Professional Professional Modifier Low / Median / High Price $115.55 / $449.88 / $695.38	Professional		$115.55	$449.88	$695.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $426.72 / $686.72 / $1,122.63	Professional		$426.72	$686.72	$1,122.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.20 / $115.85 / $182.99	Professional	26	$69.20	$115.85	$182.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $354.70 / $483.85 / $1,011.93	Professional	TC	$354.70	$483.85	$1,011.93
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $60.94 / $96.87 / $100.35	Facility	26	$60.94	$96.87	$100.35
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $418.40 / $507.85 / $721.85	Professional		$418.40	$507.85	$721.85
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $60.94 / $93.27 / $145.94	Professional	26	$60.94	$93.27	$145.94
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $357.47 / $410.97 / $585.11	Professional	TC	$357.47	$410.97	$585.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.24 / $354.56 / $518.92	Professional		$93.24	$354.56	$518.92
United Facility/Professional Professional Modifier Low / Median / High Price $429.00 / $558.95 / $800.61	Professional		$429.00	$558.95	$800.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.12 / $93.69 / $116.89	Professional	26	$71.12	$93.69	$116.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $350.90 / $442.82 / $672.31	Professional	TC	$350.90	$442.82	$672.31