Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $43.21	Facility	26	$34.29	$34.29	$43.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.78 / $60.96 / $103.36	Professional		$47.78	$60.96	$103.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.57 / $34.29 / $90.72	Professional	26	$26.57	$34.29	$90.72
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $32.00 / $35.97 / $85.19	Professional	52	$32.00	$35.97	$85.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.23 / $26.67 / $57.87	Professional	TC	$22.23	$26.67	$57.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $38.33 / $43.45 / $53.49	Professional		$38.33	$43.45	$53.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.51 / $33.78 / $45.74	Professional	26	$21.51	$33.78	$45.74
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $12.78 / $12.78 / $24.25	Professional	52	$12.78	$12.78	$24.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.26 / $31.31 / $41.33	Professional	TC	$21.26	$31.31	$41.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.86 / $74.27 / $89.91	Professional		$35.86	$74.27	$89.91
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.47 / $45.27 / $45.27	Professional	26	$38.47	$45.27	$45.27
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.60 / $38.35 / $38.35	Professional	TC	$32.60	$38.35	$38.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.62 / $34.96 / $65.73	Professional		$23.62	$34.96	$65.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.51 / $65.91 / $114.58	Professional		$42.51	$65.91	$114.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.68 / $35.94 / $70.12	Professional	26	$22.68	$35.94	$70.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.61 / $31.51 / $54.31	Professional	TC	$19.61	$31.51	$54.31
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $22.86 / $34.29 / $36.01	Facility	26	$22.86	$34.29	$36.01
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $42.01 / $60.96 / $102.01	Professional		$42.01	$60.96	$102.01
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $22.86 / $34.29 / $71.94	Professional	26	$22.86	$34.29	$71.94
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $32.00 / $35.97 / $62.57	Professional	52	$32.00	$35.97	$62.57
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $26.67 / $47.44	Professional	TC	$19.14	$26.67	$47.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $44.34 / $78.64	Professional		$28.18	$44.34	$78.64
United Facility/Professional Professional Modifier Low / Median / High Price $50.35 / $63.33 / $123.07	Professional		$50.35	$63.33	$123.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.82 / $33.72 / $49.81	Professional	26	$27.82	$33.72	$49.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.33 / $27.74 / $37.89	Professional	TC	$22.33	$27.74	$37.89