Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.92 / $17.92 / $18.82	Facility	26	$17.92	$17.92	$18.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.75 / $79.48 / $202.50	Professional		$56.75	$79.48	$202.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $17.93 / $48.11	Professional	26	$14.36	$17.93	$48.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $61.56 / $95.92	Professional	TC	$42.39	$61.56	$95.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.22 / $53.82 / $68.18	Professional		$52.22	$53.82	$68.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.70 / $15.00 / $23.00	Professional	26	$11.70	$15.00	$23.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.89 / $95.52 / $131.35	Professional		$26.89	$95.52	$131.35
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.97 / $23.97 / $23.97	Professional	26	$23.97	$23.97	$23.97
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.15 / $88.41 / $88.41	Professional	TC	$75.15	$88.41	$88.41
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.01 / $61.71 / $89.24	Professional		$16.01	$61.71	$89.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.11 / $76.27 / $150.30	Professional		$53.11	$76.27	$150.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.31 / $19.20 / $37.92	Professional	26	$12.31	$19.20	$37.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.80 / $60.06 / $117.25	Professional	TC	$41.80	$60.06	$117.25
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.43 / $17.92 / $18.82	Facility	26	$12.43	$17.92	$18.82
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $46.73 / $79.48 / $143.11	Professional		$46.73	$79.48	$143.11
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $12.43 / $17.92 / $45.54	Professional	26	$12.43	$17.92	$45.54
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $34.31 / $61.56 / $93.73	Professional	TC	$34.31	$61.56	$93.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.62 / $66.18 / $94.72	Professional		$52.62	$66.18	$94.72
United Facility/Professional Professional Modifier Low / Median / High Price $57.00 / $67.93 / $97.47	Professional		$57.00	$67.93	$97.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.65 / $17.82 / $26.62	Professional	26	$14.65	$17.82	$26.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.39 / $49.98 / $70.84	Professional	TC	$41.39	$49.98	$70.84