Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.89 / $33.89 / $42.70	Facility	26	$33.89	$33.89	$42.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.76 / $117.15 / $178.06	Professional		$93.76	$117.15	$178.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.44 / $30.45 / $52.22	Professional	26	$25.44	$30.45	$52.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.25 / $84.53 / $133.91	Professional	TC	$67.25	$84.53	$133.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.70 / $82.09 / $102.02	Professional		$78.70	$82.09	$102.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.13 / $28.26 / $42.50	Professional	26	$21.13	$28.26	$42.50
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.33 / $143.51 / $197.33	Professional		$42.33	$143.51	$197.33
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.47 / $38.47 / $45.27	Professional	26	$38.47	$38.47	$45.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $30.37 / $88.97 / $128.68	Professional		$30.37	$88.97	$128.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Facility	26	$32.36	$32.36	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.09 / $128.13 / $243.17	Professional		$82.09	$128.13	$243.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.25 / $35.47 / $80.59	Professional	26	$23.25	$35.47	$80.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.06 / $92.64 / $212.51	Professional	TC	$60.06	$92.64	$212.51
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $23.97 / $33.89 / $42.70	Facility	26	$23.97	$33.89	$42.70
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $83.49 / $114.07 / $164.29	Professional		$83.49	$114.07	$164.29
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $23.97 / $30.49 / $47.83	Professional	26	$23.97	$30.49	$47.83
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $59.52 / $82.23 / $111.57	Professional	TC	$59.52	$82.23	$111.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.29 / $81.13 / $158.16	Professional		$36.29	$81.13	$158.16
United Facility/Professional Professional Modifier Low / Median / High Price $94.00 / $117.05 / $151.38	Professional		$94.00	$117.05	$151.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.03 / $33.90 / $87.90	Professional	26	$27.03	$33.90	$87.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.67 / $83.14 / $107.90	Professional	TC	$66.67	$83.14	$107.90