Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.87 / $27.87 / $35.11	Facility	26	$27.87	$27.87	$35.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.99 / $82.34 / $236.00	Professional		$54.99	$82.34	$236.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.92 / $27.88 / $97.28	Professional	26	$16.92	$27.88	$97.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.00 / $46.09 / $100.45	Professional	TC	$24.00	$46.09	$100.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.42 / $39.72 / $49.70	Professional		$24.42	$39.72	$49.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.07 / $23.07 / $37.01	Professional	26	$18.07	$23.07	$37.01
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.82 / $21.82 / $21.82	Professional	TC	$21.82	$21.82	$21.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.86 / $45.82 / $93.38	Professional		$34.86	$45.82	$93.38
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.69 / $37.28 / $37.28	Professional	26	$31.69	$37.28	$37.28
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.22 / $42.61 / $42.61	Professional	TC	$36.22	$42.61	$42.61
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.61 / $30.84 / $59.67	Professional		$23.61	$30.84	$59.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.65 / $26.65 / $26.65	Facility	26	$26.65	$26.65	$26.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.41 / $76.89 / $171.52	Professional		$41.41	$76.89	$171.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.57 / $26.86 / $66.98	Professional	26	$17.57	$26.86	$66.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.60 / $36.74 / $96.88	Professional	TC	$20.60	$36.74	$96.88
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $15.42 / $27.87 / $35.11	Facility	26	$15.42	$27.87	$35.11
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $54.99 / $76.20 / $149.93	Professional		$54.99	$76.20	$149.93
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $15.42 / $27.87 / $86.90	Professional	26	$15.42	$27.87	$86.90
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.21 / $42.34 / $74.84	Professional	TC	$28.21	$42.34	$74.84
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 $47.18 / $64.69 / $106.34	Professional		$47.18	$64.69	$106.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.29 / $24.71 / $32.11	Professional	26	$18.29	$24.71	$32.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.97 / $39.68 / $109.68	Professional	TC	$22.97	$39.68	$109.68