Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.43 / $41.43 / $52.21	Facility	26	$41.43	$41.43	$52.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.57 / $118.18 / $184.55	Professional		$93.57	$118.18	$184.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.12 / $37.54 / $79.51	Professional	26	$31.12	$37.54	$79.51
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $191.91 / $232.10 / $783.34	Professional	50	$191.91	$232.10	$783.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.21 / $76.75 / $116.77	Professional	TC	$61.21	$76.75	$116.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.45 / $80.59 / $99.18	Professional		$72.45	$80.59	$99.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.83 / $42.98 / $67.31	Professional	26	$25.83	$42.98	$67.31
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $108.69 / $126.45 / $148.77	Professional	50	$108.69	$126.45	$148.77
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.92 / $158.49 / $350.49	Professional		$69.92	$158.49	$350.49
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.39 / $55.39 / $55.39	Professional	26	$55.39	$55.39	$55.39
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $277.07 / $325.95 / $325.95	Professional	50	$277.07	$325.95	$325.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.13 / $77.43 / $124.83	Professional		$37.13	$77.43	$124.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.52 / $128.90 / $279.60	Professional		$84.52	$128.90	$279.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.19 / $43.84 / $101.75	Professional	26	$28.19	$43.84	$101.75
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $123.38 / $157.99 / $179.75	Professional	50	$123.38	$157.99	$179.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.74 / $85.05 / $196.99	Professional	TC	$54.74	$85.05	$196.99
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $28.36 / $41.43 / $52.21	Facility	26	$28.36	$41.43	$52.21
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $81.65 / $118.18 / $180.03	Professional		$81.65	$118.18	$180.03
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $28.36 / $41.43 / $62.16	Professional	26	$28.36	$41.43	$62.16
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $132.00 / $271.42 / $749.61	Professional	50	$132.00	$271.42	$749.61
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $53.29 / $76.75 / $105.22	Professional	TC	$53.29	$76.75	$105.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.97 / $77.58 / $119.35	Professional		$35.97	$77.58	$119.35
United Facility/Professional Professional Modifier Low / Median / High Price $93.24 / $116.55 / $163.49	Professional		$93.24	$116.55	$163.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $41.00 / $54.46	Professional	26	$32.72	$41.00	$54.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.91 / $75.22 / $99.04	Professional	TC	$61.91	$75.22	$99.04