Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.33 / $30.33 / $31.85	Facility	26	$30.33	$30.33	$31.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.81 / $121.35 / $206.56	Professional		$82.81	$121.35	$206.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.87 / $28.76 / $75.93	Professional	26	$22.87	$28.76	$75.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.92 / $96.68 / $167.75	Professional	TC	$59.92	$96.68	$167.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.00 / $24.98 / $49.70	Professional	26	$20.00	$24.98	$49.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.35 / $160.63 / $218.11	Professional		$37.35	$160.63	$218.11
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.96 / $39.95 / $39.95	Professional	26	$33.96	$39.95	$39.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $26.77 / $107.94 / $154.58	Professional		$26.77	$107.94	$154.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.92 / $28.92 / $28.92	Facility	26	$28.92	$28.92	$28.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.78 / $135.58 / $266.68	Professional		$84.78	$135.58	$266.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.85 / $31.67 / $61.67	Professional	26	$19.85	$31.67	$61.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.19 / $114.19 / $214.68	Professional	TC	$56.19	$114.19	$214.68
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $20.71 / $30.33 / $31.85	Facility	26	$20.71	$30.33	$31.85
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $73.84 / $126.57 / $207.08	Professional		$73.84	$126.57	$207.08
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $20.71 / $30.33 / $71.87	Professional	26	$20.71	$30.33	$71.87
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $53.13 / $99.65 / $170.15	Professional	TC	$53.13	$99.65	$170.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $108.90 / $159.69	Professional		$34.95	$108.90	$159.69
United Facility/Professional Professional Modifier Low / Median / High Price $82.72 / $120.74 / $196.95	Professional		$82.72	$120.74	$196.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.73 / $28.62 / $44.69	Professional	26	$23.73	$28.62	$44.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.06 / $96.94 / $145.25	Professional	TC	$56.06	$96.94	$145.25