Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.99 / $34.99 / $44.08	Facility	26	$34.99	$34.99	$44.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.49 / $77.37 / $119.80	Professional		$63.49	$77.37	$119.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.02 / $31.94 / $51.00	Professional	26	$26.02	$31.94	$51.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.36 / $38.28 / $38.28	Professional	52	$21.36	$38.28	$38.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $43.74 / $71.18	Professional	TC	$33.04	$43.74	$71.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.81 / $63.15 / $126.99	Professional		$44.81	$63.15	$126.99
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.72 / $60.72 / $60.72	Professional	TC	$60.72	$60.72	$60.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $64.13 / $74.05 / $138.18	Professional		$64.13	$74.05	$138.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.27 / $92.36 / $186.89	Professional		$56.27	$92.36	$186.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.05 / $36.69 / $85.19	Professional	26	$24.05	$36.69	$85.19
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $81.44 / $97.82 / $113.96	Professional	50	$81.44	$97.82	$113.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.52 / $53.26 / $118.69	Professional	TC	$31.52	$53.26	$118.69
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $24.42 / $34.99 / $44.08	Facility	26	$24.42	$34.99	$44.08
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $76.54 / $119.80	Professional		$64.31	$76.54	$119.80
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $24.42 / $31.87 / $48.36	Professional	26	$24.42	$31.87	$48.36
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $28.47 / $38.28 / $77.00	Professional	52	$28.47	$38.28	$77.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $39.90 / $41.56 / $70.47	Professional	TC	$39.90	$41.56	$70.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.23 / $44.27 / $78.81	Professional		$28.23	$44.27	$78.81
United Facility/Professional Professional Modifier Low / Median / High Price $61.35 / $79.28 / $119.34	Professional		$61.35	$79.28	$119.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.30 / $32.44 / $47.70	Professional	26	$25.30	$32.44	$47.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.45 / $46.09 / $72.18	Professional	TC	$34.45	$46.09	$72.18