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 / $18.39	Facility	26	$17.92	$17.92	$18.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.49 / $69.81 / $114.95	Professional		$51.49	$69.81	$114.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.95 / $17.92 / $45.90	Professional	26	$13.95	$17.92	$45.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $49.67 / $81.43	Professional	TC	$37.11	$49.67	$81.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.56 / $51.17 / $113.00	Professional		$47.56	$51.17	$113.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.70 / $15.00 / $21.48	Professional	26	$11.70	$15.00	$21.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.41 / $87.99 / $123.17	Professional		$22.41	$87.99	$123.17
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.37 / $23.97 / $23.97	Professional	26	$20.37	$23.97	$23.97
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.84 / $75.09 / $75.09	Professional	TC	$63.84	$75.09	$75.09
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.01 / $53.70 / $78.72	Professional		$16.01	$53.70	$78.72
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 $45.95 / $69.30 / $132.59	Professional		$45.95	$69.30	$132.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.08 / $19.18 / $36.86	Professional	26	$12.08	$19.18	$36.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.60 / $51.66 / $99.53	Professional	TC	$35.60	$51.66	$99.53
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.43 / $17.92 / $18.25	Facility	26	$12.43	$17.92	$18.25
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $42.49 / $70.23 / $111.41	Professional		$42.49	$70.23	$111.41
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $12.43 / $17.92 / $37.88	Professional	26	$12.43	$17.92	$37.88
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $30.06 / $52.29 / $78.45	Professional	TC	$30.06	$52.29	$78.45
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 $51.45 / $59.91 / $88.75	Professional		$51.45	$59.91	$88.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.58 / $17.78 / $26.61	Professional	26	$14.58	$17.78	$26.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.29 / $43.67 / $66.20	Professional	TC	$36.29	$43.67	$66.20