Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.64 / $55.28 / $66.33	Facility	26	$52.64	$55.28	$66.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.00 / $116.73 / $345.24	Professional		$84.00	$116.73	$345.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.60 / $50.39 / $108.23	Professional	26	$43.60	$50.39	$108.23
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $325.39 / $325.39 / $325.39	Professional	50	$325.39	$325.39	$325.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.17 / $52.99 / $80.92	Professional	TC	$40.17	$52.99	$80.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.02 / $90.49 / $117.64	Professional		$85.02	$90.49	$117.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.54 / $52.32 / $75.45	Professional	26	$40.54	$52.32	$75.45
BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.93 / $132.47 / $167.33	Professional		$62.93	$132.47	$167.33
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $126.76 / $149.13 / $149.13	Professional	50	$126.76	$149.13	$149.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $46.03 / $58.08 / $116.05	Professional		$46.03	$58.08	$116.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.99 / $134.30 / $407.16	Professional		$82.99	$134.30	$407.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.79 / $64.75 / $189.91	Professional	26	$38.79	$64.75	$189.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.15 / $74.42 / $217.25	Professional	TC	$44.15	$74.42	$217.25
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $46.23 / $52.64 / $66.33	Facility	26	$46.23	$52.64	$66.33
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $85.10 / $111.18 / $324.54	Professional		$85.10	$111.18	$324.54
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $52.64 / $95.18	Professional	26	$43.82	$52.64	$95.18
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $325.39 / $325.39 / $325.39	Professional	50	$325.39	$325.39	$325.39
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $38.88 / $58.53 / $77.25	Professional	TC	$38.88	$58.53	$77.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $46.17 / $120.26	Professional		$28.58	$46.17	$120.26
United Facility/Professional Professional Modifier Low / Median / High Price $88.77 / $103.24 / $140.32	Professional		$88.77	$103.24	$140.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.44 / $53.27 / $76.15	Professional	26	$45.44	$53.27	$76.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.48 / $51.97 / $77.58	Professional	TC	$42.48	$51.97	$77.58