Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.03 / $40.03 / $50.45	Facility	26	$40.03	$40.03	$50.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $99.70 / $170.34	Professional		$64.31	$99.70	$170.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.26 / $35.20 / $52.84	Professional	26	$31.26	$35.20	$52.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $65.09 / $83.30	Professional	TC	$33.03	$65.09	$83.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.27 / $101.27 / $112.00	Professional		$101.27	$101.27	$112.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.53 / $31.89 / $33.28	Professional	26	$29.53	$31.89	$33.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.30 / $158.96 / $252.58	Professional		$52.30	$158.96	$252.58
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.79 / $53.79 / $53.79	Professional	26	$53.79	$53.79	$53.79
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.12 / $108.12 / $108.12	Professional	TC	$108.12	$108.12	$108.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.04 / $75.50 / $125.31	Professional		$36.04	$75.50	$125.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.77 / $121.44 / $441.69	Professional		$71.77	$121.44	$441.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $52.10 / $143.87	Professional	26	$29.51	$52.10	$143.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.08 / $74.48 / $297.82	Professional	TC	$30.08	$74.48	$297.82
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $32.74 / $40.03 / $50.45	Facility	26	$32.74	$40.03	$50.45
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $68.02 / $102.99 / $166.02	Professional		$68.02	$102.99	$166.02
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $31.36 / $36.89 / $52.98	Professional	26	$31.36	$36.89	$52.98
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $34.52 / $60.87 / $91.82	Professional	TC	$34.52	$60.87	$91.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.83 / $78.19 / $122.43	Professional		$35.83	$78.19	$122.43
United Facility/Professional Professional Modifier Low / Median / High Price $57.29 / $86.40 / $130.34	Professional		$57.29	$86.40	$130.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.61 / $39.29 / $56.58	Professional	26	$33.61	$39.29	$56.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.55 / $51.17 / $75.34	Professional	TC	$21.55	$51.17	$75.34