Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.25 / $89.25 / $93.71	Facility	26	$89.25	$89.25	$93.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $433.43 / $492.40 / $794.63	Professional		$433.43	$492.40	$794.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.62 / $89.25 / $201.19	Professional	26	$67.62	$89.25	$201.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $365.81 / $414.12 / $601.36	Professional	TC	$365.81	$414.12	$601.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $345.84 / $378.15 / $528.92	Professional		$345.84	$378.15	$528.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.67 / $95.16 / $145.26	Professional	26	$58.67	$95.16	$145.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $307.35 / $307.35 / $307.35	Professional	TC	$307.35	$307.35	$307.35
BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.05 / $576.62 / $699.84	Professional		$111.05	$576.62	$699.84
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.77 / $118.77 / $118.77	Professional	26	$118.77	$118.77	$118.77
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $554.44 / $554.44 / $554.44	Professional	TC	$554.44	$554.44	$554.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $105.26 / $505.65 / $838.15	Professional		$105.26	$505.65	$838.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $386.27 / $617.95 / $1,061.60	Professional		$386.27	$617.95	$1,061.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.77 / $105.71 / $163.74	Professional	26	$57.77	$105.71	$163.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $322.83 / $621.16 / $946.82	Professional	TC	$322.83	$621.16	$946.82
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $60.53 / $89.25 / $93.71	Facility	26	$60.53	$89.25	$93.71
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $393.19 / $492.39 / $779.80	Professional		$393.19	$492.39	$779.80
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $60.53 / $89.25 / $206.64	Professional	26	$60.53	$89.25	$206.64
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $332.67 / $403.14 / $604.73	Professional	TC	$332.67	$403.14	$604.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.78 / $324.14 / $492.50	Professional		$93.78	$324.14	$492.50
United Facility/Professional Professional Modifier Low / Median / High Price $448.88 / $541.99 / $766.44	Professional		$448.88	$541.99	$766.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.98 / $94.50 / $131.08	Professional	26	$75.98	$94.50	$131.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $343.26 / $438.35 / $628.92	Professional	TC	$343.26	$438.35	$628.92