Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.75 / $73.75 / $92.92	Facility	26	$73.75	$73.75	$92.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.95 / $101.04 / $157.72	Professional		$77.95	$101.04	$157.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.17 / $62.40 / $95.14	Professional	26	$51.17	$62.40	$95.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.10 / $40.75 / $57.90	Professional	TC	$25.10	$40.75	$57.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $73.50 / $88.90 / $122.19	Professional		$73.50	$88.90	$122.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.89 / $64.67 / $124.12	Professional	26	$53.89	$64.67	$124.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $65.36 / $98.00 / $165.51	Professional		$65.36	$98.00	$165.51
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.25 / $74.25 / $87.35	Professional	26	$74.25	$74.25	$87.35
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.58 / $66.58 / $66.58	Professional	TC	$66.58	$66.58	$66.58
CareSource Facility/Professional Professional Modifier Low / Median / High Price $42.91 / $61.50 / $112.61	Professional		$42.91	$61.50	$112.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.09 / $126.26 / $413.75	Professional		$92.09	$126.26	$413.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.39 / $83.12 / $231.93	Professional	26	$61.39	$83.12	$231.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.83 / $41.95 / $181.82	Professional	TC	$28.83	$41.95	$181.82
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $55.97 / $73.75 / $92.92	Facility	26	$55.97	$73.75	$92.92
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $79.45 / $105.56 / $165.76	Professional		$79.45	$105.56	$165.76
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $53.96 / $68.91 / $104.41	Professional	26	$53.96	$68.91	$104.41
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $23.49 / $42.74 / $65.09	Professional	TC	$23.49	$42.74	$65.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.42 / $45.42 / $119.03	Professional		$28.42	$45.42	$119.03
United Facility/Professional Professional Modifier Low / Median / High Price $80.59 / $95.29 / $131.49	Professional		$80.59	$95.29	$131.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $65.90 / $95.20	Professional	26	$55.15	$65.90	$95.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.58 / $30.63 / $46.35	Professional	TC	$24.58	$30.63	$46.35