Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.72 / $51.15 / $61.38	Facility	26	$48.72	$51.15	$61.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.03 / $154.36 / $275.00	Professional		$119.03	$154.36	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.22 / $48.71 / $119.20	Professional	26	$36.22	$48.71	$119.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $604.69 / $604.69 / $604.69	Professional	50	$604.69	$604.69	$604.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.64 / $104.18 / $200.77	Professional	TC	$78.64	$104.18	$200.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.41 / $151.41 / $151.41	Professional		$151.41	$151.41	$151.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.70 / $54.70 / $54.70	Professional	26	$54.70	$54.70	$54.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.25 / $198.72 / $261.45	Professional		$62.25	$198.72	$261.45
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.58 / $66.58 / $66.58	Professional	26	$66.58	$66.58	$66.58
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $184.81 / $184.81 / $184.81	Professional	TC	$184.81	$184.81	$184.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $44.23 / $132.97 / $200.76	Professional		$44.23	$132.97	$200.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.14 / $47.14 / $47.14	Facility	26	$47.14	$47.14	$47.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.61 / $145.88 / $338.14	Professional		$85.61	$145.88	$338.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.52 / $52.64 / $98.47	Professional	26	$30.52	$52.64	$98.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.73 / $93.36 / $243.19	Professional	TC	$48.73	$93.36	$243.19
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $44.59 / $44.59 / $61.38	Facility	26	$44.59	$44.59	$61.38
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $127.16 / $152.83 / $267.42	Professional		$127.16	$152.83	$267.42
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $42.75 / $48.71 / $119.20	Professional	26	$42.75	$48.71	$119.20
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $604.69 / $604.69 / $604.69	Professional	50	$604.69	$604.69	$604.69
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $84.40 / $102.34 / $150.57	Professional	TC	$84.40	$102.34	$150.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $119.60 / $193.91	Professional		$35.58	$119.60	$193.91
United Facility/Professional Professional Modifier Low / Median / High Price $98.52 / $127.63 / $187.06	Professional		$98.52	$127.63	$187.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.22 / $48.43 / $70.01	Professional	26	$38.22	$48.43	$70.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.10 / $78.25 / $139.30	Professional	TC	$54.10	$78.25	$139.30