Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.02 / $55.02 / $69.31	Facility	26	$55.02	$55.02	$69.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.72 / $82.01 / $126.31	Professional		$63.72	$82.01	$126.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.95 / $47.02 / $73.37	Professional	26	$37.95	$47.02	$73.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.73 / $39.07 / $53.96	Professional	TC	$21.73	$39.07	$53.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.18 / $76.36 / $108.06	Professional		$67.18	$76.36	$108.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.69 / $53.69 / $98.49	Professional	26	$53.69	$53.69	$98.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.23 / $111.17 / $140.41	Professional		$54.23	$111.17	$140.41
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.77 / $54.77 / $64.44	Professional	26	$54.77	$54.77	$64.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.72 / $60.72 / $60.72	Professional	TC	$60.72	$60.72	$60.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.81 / $47.18 / $91.12	Professional		$37.81	$47.18	$91.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.47 / $102.65 / $337.87	Professional		$74.47	$102.65	$337.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.20 / $62.19 / $171.80	Professional	26	$45.20	$62.19	$171.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.36 / $37.72 / $166.07	Professional	TC	$25.36	$37.72	$166.07
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $41.32 / $55.02 / $57.77	Facility	26	$41.32	$55.02	$57.77
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $61.86 / $85.62 / $129.15	Professional		$61.86	$85.62	$129.15
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.54 / $50.18 / $78.41	Professional	26	$39.54	$50.18	$78.41
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.55 / $39.11 / $59.60	Professional	TC	$20.55	$39.11	$59.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $45.42 / $79.93	Professional		$28.18	$45.42	$79.93
United Facility/Professional Professional Modifier Low / Median / High Price $65.29 / $78.43 / $104.26	Professional		$65.29	$78.43	$104.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.63 / $48.44 / $70.06	Professional	26	$39.63	$48.44	$70.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.00 / $26.66 / $39.71	Professional	TC	$21.00	$26.66	$39.71