Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.78 / $32.78 / $41.30	Facility	26	$32.78	$32.78	$41.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.77 / $79.34 / $183.20	Professional		$53.77	$79.34	$183.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $32.78 / $92.04	Professional	26	$23.46	$32.78	$92.04
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.56 / $32.72 / $53.56	Professional	52	$21.56	$32.72	$53.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.64 / $55.15 / $99.00	Professional	TC	$27.64	$55.15	$99.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.89 / $56.77 / $57.16	Professional		$34.89	$56.77	$57.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.55 / $27.07 / $38.72	Professional	26	$21.55	$27.07	$38.72
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $12.06 / $12.06 / $12.06	Professional	52	$12.06	$12.06	$12.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.36 / $62.52 / $99.65	Professional		$39.36	$62.52	$99.65
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.67 / $43.14 / $43.14	Professional	26	$36.67	$43.14	$43.14
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.10 / $42.10 / $49.53	Professional	TC	$42.10	$42.10	$49.53
CareSource Facility/Professional Professional Modifier Low / Median / High Price $27.44 / $35.86 / $69.30	Professional		$27.44	$35.86	$69.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.97 / $30.97 / $30.97	Facility	26	$30.97	$30.97	$30.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.87 / $90.69 / $183.67	Professional		$51.87	$90.69	$183.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.58 / $31.83 / $78.77	Professional	26	$21.58	$31.83	$78.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $59.00 / $118.14	Professional	TC	$28.84	$59.00	$118.14
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $21.24 / $32.78 / $41.30	Facility	26	$21.24	$32.78	$41.30
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $63.39 / $70.41 / $150.91	Professional		$63.39	$70.41	$150.91
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $21.24 / $32.78 / $76.89	Professional	26	$21.24	$32.78	$76.89
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $25.04 / $32.72 / $119.60	Professional	52	$25.04	$32.72	$119.60
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.67 / $49.16 / $82.69	Professional	TC	$32.67	$49.16	$82.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.23 / $44.27 / $78.80	Professional		$28.23	$44.27	$78.80
United Facility/Professional Professional Modifier Low / Median / High Price $68.41 / $89.41 / $124.76	Professional		$68.41	$89.41	$124.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.80 / $29.59 / $40.09	Professional	26	$23.80	$29.59	$40.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.26 / $58.63 / $82.45	Professional	TC	$43.26	$58.63	$82.45