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 / $19.51	Facility	26	$15.49	$15.49	$19.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $66.64 / $109.49	Professional		$46.93	$66.64	$109.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.18 / $14.74 / $31.29	Professional	26	$12.18	$14.74	$31.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.14 / $44.07 / $89.08	Professional	TC	$34.14	$44.07	$89.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.07 / $50.07 / $50.07	Professional		$50.07	$50.07	$50.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.42 / $12.51 / $18.05	Professional	26	$10.42	$12.51	$18.05
BCBS Facility/Professional Professional Modifier Low / Median / High Price $20.72 / $78.66 / $108.76	Professional		$20.72	$78.66	$108.76
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.11 / $21.30 / $21.30	Professional	26	$18.11	$21.30	$21.30
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.29 / $75.63 / $75.63	Professional	TC	$64.29	$75.63	$75.63
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.18 / $52.76 / $76.90	Professional		$14.18	$52.76	$76.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $15.00 / $15.00	Facility	26	$15.00	$15.00	$15.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.32 / $67.70 / $129.53	Professional		$44.32	$67.70	$129.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.82 / $17.17 / $32.32	Professional	26	$10.82	$17.17	$32.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.70 / $48.75 / $100.24	Professional	TC	$33.70	$48.75	$100.24
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $11.10 / $15.49 / $15.49	Facility	26	$11.10	$15.49	$15.49
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $38.77 / $65.59 / $109.49	Professional		$38.77	$65.59	$109.49
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.10 / $14.74 / $31.29	Professional	26	$11.10	$14.74	$31.29
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $27.67 / $48.77 / $86.79	Professional	TC	$27.67	$48.77	$86.79
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 $47.00 / $56.41 / $80.93	Professional		$47.00	$56.41	$80.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.01 / $15.58 / $23.69	Professional	26	$13.01	$15.58	$23.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.02 / $40.46 / $57.24	Professional	TC	$34.02	$40.46	$57.24