Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.71 / $48.71 / $61.37	Facility	26	$48.71	$48.71	$61.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.50 / $81.03 / $133.63	Professional		$59.50	$81.03	$133.63
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $113.88 / $113.88 / $113.88	Professional	25	$113.88	$113.88	$113.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.97 / $44.94 / $91.08	Professional	26	$34.97	$44.94	$91.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.05 / $39.89 / $57.87	Professional	TC	$21.05	$39.89	$57.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.84 / $75.13 / $171.27	Professional		$70.84	$75.13	$171.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.21 / $35.34 / $82.14	Professional	26	$34.21	$35.34	$82.14
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.78 / $83.36 / $132.86	Professional		$53.78	$83.36	$132.86
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.89 / $48.89 / $57.52	Professional	26	$48.89	$48.89	$57.52
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.04 / $66.04 / $66.04	Professional	TC	$66.04	$66.04	$66.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.84 / $44.47 / $89.58	Professional		$36.84	$44.47	$89.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.95 / $98.02 / $335.01	Professional		$68.95	$98.02	$335.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $56.06 / $154.62	Professional	26	$40.72	$56.06	$154.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.29 / $39.83 / $180.39	Professional	TC	$25.29	$39.83	$180.39
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $38.04 / $48.71 / $51.14	Facility	26	$38.04	$48.71	$51.14
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $57.94 / $84.25 / $133.63	Professional		$57.94	$84.25	$133.63
Health Alliance Plan Facility/Professional Professional Modifier 25 Low / Median / High Price $113.88 / $113.88 / $113.88	Professional	25	$113.88	$113.88	$113.88
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $36.77 / $47.89 / $79.20	Professional	26	$36.77	$47.89	$79.20
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $42.40 / $64.59	Professional	TC	$19.89	$42.40	$64.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $45.42 / $119.03	Professional		$28.18	$45.42	$119.03
United Facility/Professional Professional Modifier Low / Median / High Price $61.16 / $73.06 / $101.56	Professional		$61.16	$73.06	$101.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.22 / $44.80 / $63.15	Professional	26	$37.22	$44.80	$63.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.30 / $26.44 / $42.95	Professional	TC	$20.30	$26.44	$42.95