Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $15.49 / $18.12	Facility	26	$15.49	$15.49	$18.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.71 / $60.90 / $153.59	Professional		$47.71	$60.90	$153.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $15.49 / $42.95	Professional	26	$12.37	$15.49	$42.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.09 / $44.89 / $73.80	Professional	TC	$34.09	$44.89	$73.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.10 / $48.68 / $55.56	Professional		$40.10	$48.68	$55.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.03 / $12.70 / $24.66	Professional	26	$10.03	$12.70	$24.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.43 / $39.47 / $55.58	Professional	TC	$28.43	$39.47	$55.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.42 / $68.13 / $107.43	Professional		$19.42	$68.13	$107.43
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.64 / $20.77 / $20.77	Professional	26	$17.64	$20.77	$20.77
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.68 / $65.51 / $65.51	Professional	TC	$55.68	$65.51	$65.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $13.97 / $46.68 / $68.68	Professional		$13.97	$46.68	$68.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.28 / $59.99 / $115.69	Professional		$40.28	$59.99	$115.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.45 / $18.34 / $34.22	Professional	26	$10.45	$18.34	$34.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.10 / $43.51 / $86.79	Professional	TC	$27.10	$43.51	$86.79
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.78 / $15.49 / $16.26	Facility	26	$12.78	$15.49	$16.26
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $43.15 / $60.38 / $111.06	Professional		$43.15	$60.38	$111.06
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $12.78 / $15.49 / $40.33	Professional	26	$12.78	$15.49	$40.33
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $30.37 / $44.89 / $71.13	Professional	TC	$30.37	$44.89	$71.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $33.09 / $47.38	Professional		$26.52	$33.09	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $46.13 / $53.02 / $73.64	Professional		$46.13	$53.02	$73.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.37 / $16.88 / $41.12	Professional	26	$13.37	$16.88	$41.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.15 / $37.11 / $50.29	Professional	TC	$30.15	$37.11	$50.29