Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.93 / $54.93 / $69.22	Facility	26	$54.93	$54.93	$69.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.89 / $145.06 / $234.33	Professional		$87.89	$145.06	$234.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.71 / $36.25 / $62.50	Professional	26	$15.71	$36.25	$62.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.50 / $87.23 / $187.57	Professional	TC	$45.50	$87.23	$187.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.47 / $38.75 / $86.32	Professional	26	$34.47	$38.75	$86.32
BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.72 / $142.91 / $171.50	Professional		$67.72	$142.91	$171.50
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.43 / $72.43 / $72.43	Professional	26	$72.43	$72.43	$72.43
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.42 / $80.42 / $80.42	Professional	TC	$80.42	$80.42	$80.42
CareSource Facility/Professional Professional Modifier Low / Median / High Price $44.54 / $60.42 / $119.74	Professional		$44.54	$60.42	$119.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $52.72 / $52.72	Facility	26	$52.72	$52.72	$52.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.31 / $152.80 / $481.90	Professional		$77.31	$152.80	$481.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $33.84 / $100.02	Professional	26	$16.67	$33.84	$100.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $97.14 / $476.92	Professional	TC	$44.67	$97.14	$476.92
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $14.36 / $54.93 / $57.68	Facility	26	$14.36	$54.93	$57.68
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $103.76 / $112.06 / $179.45	Professional		$103.76	$112.06	$179.45
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $39.33 / $67.92	Professional	26	$14.36	$39.33	$67.92
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $53.49 / $89.38 / $158.74	Professional	TC	$53.49	$89.38	$158.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.47 / $76.59 / $117.12	Professional		$34.47	$76.59	$117.12
United Facility/Professional Professional Modifier Low / Median / High Price $93.94 / $131.65 / $343.88	Professional		$93.94	$131.65	$343.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.26 / $25.51 / $59.76	Professional	26	$17.26	$25.51	$59.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.34 / $80.09 / $324.37	Professional	TC	$56.34	$80.09	$324.37