Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.29 / $36.29 / $45.73	Facility	26	$36.29	$36.29	$45.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.24 / $125.23 / $398.83	Professional		$91.24	$125.23	$398.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.82 / $38.97 / $156.75	Professional	26	$27.82	$38.97	$156.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.98 / $95.68 / $180.49	Professional	TC	$62.98	$95.68	$180.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.59 / $76.81 / $96.90	Professional		$70.59	$76.81	$96.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.43 / $30.01 / $60.36	Professional	26	$22.43	$30.01	$60.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.28 / $67.13 / $67.13	Professional	TC	$48.28	$67.13	$67.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.81 / $111.35 / $178.68	Professional		$44.81	$111.35	$178.68
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $47.93 / $47.93	Professional	26	$40.74	$47.93	$47.93
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.61 / $94.61 / $111.31	Professional	TC	$94.61	$94.61	$111.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.22 / $80.17 / $121.70	Professional		$32.22	$80.17	$121.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.36 / $34.36 / $34.36	Facility	26	$34.36	$34.36	$34.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.15 / $122.63 / $271.94	Professional		$71.15	$122.63	$271.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.21 / $36.77 / $86.29	Professional	26	$24.21	$36.77	$86.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.28 / $76.78 / $202.68	Professional	TC	$37.28	$76.78	$202.68
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $25.15 / $36.29 / $45.73	Facility	26	$25.15	$36.29	$45.73
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $97.33 / $115.27 / $226.59	Professional		$97.33	$115.27	$226.59
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $25.15 / $36.29 / $113.48	Professional	26	$25.15	$36.29	$113.48
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $70.11 / $80.56 / $156.59	Professional	TC	$70.11	$80.56	$156.59
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 $79.20 / $108.59 / $152.03	Professional		$79.20	$108.59	$152.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.25 / $34.29 / $47.20	Professional	26	$28.25	$34.29	$47.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.12 / $74.34 / $111.53	Professional	TC	$42.12	$74.34	$111.53