Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.61 / $42.61 / $53.70	Facility	26	$42.61	$42.61	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.95 / $111.73 / $383.06	Professional		$88.95	$111.73	$383.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.13 / $45.68 / $170.05	Professional	26	$32.13	$45.68	$170.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.14 / $64.31 / $129.02	Professional	TC	$54.14	$64.31	$129.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.59 / $89.07 / $167.06	Professional		$68.59	$89.07	$167.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.94 / $40.08 / $62.87	Professional	26	$27.94	$40.08	$62.87
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.10 / $46.10 / $97.45	Professional	TC	$46.10	$46.10	$97.45
BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.79 / $130.10 / $171.19	Professional		$52.79	$130.10	$171.19
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.99 / $56.46 / $56.46	Professional	26	$47.99	$56.46	$56.46
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $76.51 / $90.01 / $90.01	Professional	TC	$76.51	$90.01	$90.01
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.04 / $64.79 / $109.60	Professional		$38.04	$64.79	$109.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.86 / $40.86 / $40.86	Facility	26	$40.86	$40.86	$40.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.53 / $114.95 / $249.43	Professional		$78.53	$114.95	$249.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.06 / $44.22 / $104.59	Professional	26	$29.06	$44.22	$104.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.71 / $71.04 / $163.81	Professional	TC	$48.71	$71.04	$163.81
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $29.18 / $42.61 / $53.70	Facility	26	$29.18	$42.61	$53.70
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $82.57 / $106.41 / $256.27	Professional		$82.57	$106.41	$256.27
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $29.18 / $42.62 / $103.62	Professional	26	$29.18	$42.62	$103.62
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $53.40 / $63.79 / $116.31	Professional	TC	$53.40	$63.79	$116.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.32 / $79.45 / $123.28	Professional		$36.32	$79.45	$123.28
United Facility/Professional Professional Modifier Low / Median / High Price $85.88 / $105.51 / $146.16	Professional		$85.88	$105.51	$146.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.63 / $41.45 / $95.00	Professional	26	$32.63	$41.45	$95.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.31 / $66.97 / $96.45	Professional	TC	$54.31	$66.97	$96.45