Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $493.89 / $493.90 / $622.30	Facility	26	$493.89	$493.90	$622.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,889.42 / $2,095.90 / $3,163.96	Professional		$1,889.42	$2,095.90	$3,163.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $347.37 / $493.89 / $1,003.14	Professional	26	$347.37	$493.89	$1,003.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,542.03 / $1,649.83 / $2,474.75	Professional	TC	$1,542.03	$1,649.83	$2,474.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,666.75 / $1,793.62 / $1,972.98	Professional		$1,666.75	$1,793.62	$1,972.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $340.35 / $417.81 / $600.63	Professional	26	$340.35	$417.81	$600.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $596.16 / $2,677.02 / $3,015.17	Professional		$596.16	$2,677.02	$3,015.17
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $637.62 / $637.62 / $637.62	Professional	26	$637.62	$637.62	$637.62
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $2,376.21 / $2,376.21 / $2,376.21	Professional	TC	$2,376.21	$2,376.21	$2,376.21
CareSource Facility/Professional Professional Modifier Low / Median / High Price $592.85 / $1,801.23 / $2,784.16	Professional		$592.85	$1,801.23	$2,784.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,695.98 / $2,333.57 / $4,222.62	Professional		$1,695.98	$2,333.57	$4,222.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $355.42 / $550.55 / $936.70	Professional	26	$355.42	$550.55	$936.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,333.34 / $1,873.68 / $3,544.96	Professional	TC	$1,333.34	$1,873.68	$3,544.96
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $314.37 / $493.89 / $502.79	Facility	26	$314.37	$493.89	$502.79
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $1,555.77 / $2,068.55 / $2,773.39	Professional		$1,555.77	$2,068.55	$2,773.39
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $314.37 / $493.89 / $906.94	Professional	26	$314.37	$493.89	$906.94
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $1,241.41 / $1,574.66 / $2,338.86	Professional	TC	$1,241.41	$1,574.66	$2,338.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $374.05 / $1,396.55 / $2,075.70	Professional		$374.05	$1,396.55	$2,075.70
United Facility/Professional Professional Modifier Low / Median / High Price $1,747.29 / $2,225.77 / $3,060.44	Professional		$1,747.29	$2,225.77	$3,060.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $363.86 / $469.37 / $657.62	Professional	26	$363.86	$469.37	$657.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,425.21 / $1,759.68 / $2,382.21	Professional	TC	$1,425.21	$1,759.68	$2,382.21