Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.62 / $65.62 / $82.68	Facility	26	$65.62	$65.62	$82.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $244.44 / $300.76 / $616.25	Professional		$244.44	$300.76	$616.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.36 / $84.59 / $254.49	Professional	26	$58.36	$84.59	$254.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.34 / $235.13 / $388.49	Professional	TC	$162.34	$235.13	$388.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $176.37 / $214.68 / $328.34	Professional		$176.37	$214.68	$328.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.11 / $70.45 / $103.52	Professional	26	$41.11	$70.45	$103.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.67 / $342.87 / $466.70	Professional		$80.67	$342.87	$466.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $57.63 / $230.05 / $316.10	Professional		$57.63	$230.05	$316.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $256.32 / $355.46 / $755.85	Professional		$256.32	$355.46	$755.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.61 / $86.10 / $163.94	Professional	26	$54.61	$86.10	$163.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $200.96 / $286.55 / $591.90	Professional	TC	$200.96	$286.55	$591.90
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $65.62 / $65.62 / $88.91	Facility	26	$65.62	$65.62	$88.91
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $252.57 / $352.78 / $485.41	Professional		$252.57	$352.78	$485.41
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $58.44 / $88.91 / $187.68	Professional	26	$58.44	$88.91	$187.68
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $178.58 / $258.64 / $357.62	Professional	TC	$178.58	$258.64	$357.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $222.47 / $336.19	Professional		$36.43	$222.47	$336.19
United Facility/Professional Professional Modifier Low / Median / High Price $282.45 / $369.63 / $489.74	Professional		$282.45	$369.63	$489.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.83 / $90.51 / $115.86	Professional	26	$58.83	$90.51	$115.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $222.91 / $279.08 / $379.68	Professional	TC	$222.91	$279.08	$379.68