Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.14 / $17.14 / $18.00	Facility	26	$17.14	$17.14	$18.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.84 / $70.56 / $111.56	Professional		$57.84	$70.56	$111.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.88 / $17.14 / $38.47	Professional	26	$13.88	$17.14	$38.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.86 / $53.41 / $89.71	Professional	TC	$42.86	$53.41	$89.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.17 / $60.20 / $60.20	Professional		$51.17	$60.20	$60.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.20 / $17.22 / $25.05	Professional	26	$11.20	$17.22	$25.05
BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.41 / $87.99 / $111.14	Professional		$21.41	$87.99	$111.14
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.90 / $22.90 / $22.90	Professional	26	$22.90	$22.90	$22.90
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.73 / $76.16 / $76.16	Professional	TC	$64.73	$76.16	$76.16
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.30 / $53.66 / $78.68	Professional		$15.30	$53.66	$78.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.93 / $74.55 / $132.53	Professional		$49.93	$74.55	$132.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.20 / $20.74 / $37.82	Professional	26	$12.20	$20.74	$37.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.39 / $54.63 / $102.04	Professional	TC	$35.39	$54.63	$102.04
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $14.90 / $17.14 / $18.00	Facility	26	$14.90	$17.14	$18.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $55.06 / $70.56 / $111.56	Professional		$55.06	$70.56	$111.56
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $14.90 / $17.14 / $33.44	Professional	26	$14.90	$17.14	$33.44
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $40.17 / $53.40 / $82.60	Professional	TC	$40.17	$53.40	$82.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $50.77 / $80.02	Professional		$28.58	$50.77	$80.02
United Facility/Professional Professional Modifier Low / Median / High Price $55.10 / $66.26 / $90.60	Professional		$55.10	$66.26	$90.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.75 / $18.72 / $27.50	Professional	26	$14.75	$18.72	$27.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.17 / $46.88 / $66.26	Professional	TC	$39.17	$46.88	$66.26