Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.93 / $50.93 / $64.18	Facility	26	$50.93	$50.93	$64.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.68 / $98.82 / $218.81	Professional		$51.68	$98.82	$218.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $50.93 / $112.10	Professional	26	$24.78	$50.93	$112.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.28 / $22.47 / $114.43	Professional	TC	$12.28	$22.47	$114.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.67 / $52.71 / $65.89	Professional		$32.67	$52.71	$65.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.74 / $54.95 / $58.46	Professional	26	$31.74	$54.95	$58.46
BCBS Facility/Professional Professional Modifier Low / Median / High Price $15.93 / $84.66 / $177.26	Professional		$15.93	$84.66	$177.26
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.94 / $68.17 / $68.17	Professional	26	$57.94	$68.17	$68.17
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $170.44 / $170.44 / $170.44	Professional	50	$170.44	$170.44	$170.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.04 / $17.04 / $17.04	Professional	TC	$17.04	$17.04	$17.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.45 / $49.28 / $67.42	Professional		$10.45	$49.28	$67.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.42 / $121.93 / $206.97	Professional		$58.42	$121.93	$206.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.62 / $37.86 / $104.13	Professional	26	$27.62	$37.86	$104.13
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $115.21 / $131.31 / $199.13	Professional	50	$115.21	$131.31	$199.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.46 / $64.56 / $143.91	Professional	TC	$11.46	$64.56	$143.91
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $24.36 / $50.93 / $64.18	Facility	26	$24.36	$50.93	$64.18
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $56.85 / $96.80 / $175.77	Professional		$56.85	$96.80	$175.77
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $24.36 / $50.93 / $99.88	Professional	26	$24.36	$50.93	$99.88
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $12.19 / $24.95 / $101.19	Professional	TC	$12.19	$24.95	$101.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $61.81 / $86.24	Professional		$32.34	$61.81	$86.24
United Facility/Professional Professional Modifier Low / Median / High Price $67.18 / $122.20 / $166.72	Professional		$67.18	$122.20	$166.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.96 / $35.38 / $87.90	Professional	26	$28.96	$35.38	$87.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.79 / $86.58 / $116.05	Professional	TC	$39.79	$86.58	$116.05