Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.42 / $45.42 / $47.70	Facility	26	$45.42	$45.42	$47.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $111.53 / $142.56 / $400.90	Professional		$111.53	$142.56	$400.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.46 / $45.43 / $122.76	Professional	26	$34.46	$45.43	$122.76
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $129.36 / $129.36 / $164.10	Professional	52	$129.36	$129.36	$164.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.48 / $97.13 / $164.93	Professional	TC	$79.48	$97.13	$164.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.53 / $96.84 / $122.11	Professional		$81.53	$96.84	$122.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.67 / $40.96 / $66.14	Professional	26	$30.67	$40.96	$66.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $114.00 / $114.00 / $114.00	Professional	TC	$114.00	$114.00	$114.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.77 / $163.71 / $229.72	Professional		$56.77	$163.71	$229.72
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.72 / $60.72 / $60.72	Professional	26	$60.72	$60.72	$60.72
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $119.06 / $140.07 / $140.07	Professional	TC	$119.06	$140.07	$140.07
CareSource Facility/Professional Professional Modifier Low / Median / High Price $40.79 / $100.85 / $160.22	Professional		$40.79	$100.85	$160.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.58 / $163.51 / $276.23	Professional		$106.58	$163.51	$276.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.83 / $47.11 / $95.89	Professional	26	$29.83	$47.11	$95.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.75 / $116.83 / $200.53	Professional	TC	$75.75	$116.83	$200.53
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $30.30 / $45.42 / $47.70	Facility	26	$30.30	$45.42	$47.70
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $100.70 / $142.56 / $260.19	Professional		$100.70	$142.56	$260.19
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.30 / $45.42 / $102.60	Professional	26	$30.30	$45.42	$102.60
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $129.36 / $129.36 / $164.10	Professional	52	$129.36	$129.36	$164.10
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $70.41 / $97.12 / $155.34	Professional	TC	$70.41	$97.12	$155.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $108.90 / $159.69	Professional		$34.95	$108.90	$159.69
United Facility/Professional Professional Modifier Low / Median / High Price $121.37 / $142.79 / $205.67	Professional		$121.37	$142.79	$205.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $46.05 / $92.09	Professional	26	$36.61	$46.05	$92.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.75 / $99.17 / $141.84	Professional	TC	$84.75	$99.17	$141.84