Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $36.01	Facility	26	$34.29	$34.29	$36.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.68 / $100.19 / $171.03	Professional		$81.68	$100.19	$171.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $27.77 / $58.71	Professional	26	$19.89	$27.77	$58.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.79 / $75.80 / $117.35	Professional	TC	$61.79	$75.80	$117.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $71.53 / $71.53 / $93.53	Professional		$71.53	$71.53	$93.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.02 / $28.15 / $53.80	Professional	26	$22.02	$28.15	$53.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.33 / $114.74 / $177.31	Professional		$42.33	$114.74	$177.31
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.47 / $45.27 / $45.27	Professional	26	$38.47	$45.27	$45.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $30.41 / $77.81 / $122.44	Professional		$30.41	$77.81	$122.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.84 / $117.81 / $206.56	Professional		$75.84	$117.81	$206.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.51 / $34.21 / $70.12	Professional	26	$20.51	$34.21	$70.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.71 / $84.70 / $158.86	Professional	TC	$50.71	$84.70	$158.86
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $18.07 / $34.29 / $36.01	Facility	26	$18.07	$34.29	$36.01
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $72.79 / $107.62 / $171.03	Professional		$72.79	$107.62	$171.03
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $18.07 / $30.52 / $51.14	Professional	26	$18.07	$30.52	$51.14
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $54.72 / $77.97 / $117.35	Professional	TC	$54.72	$77.97	$117.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.95 / $76.59 / $117.12	Professional		$34.95	$76.59	$117.12
United Facility/Professional Professional Modifier Low / Median / High Price $76.13 / $94.28 / $137.99	Professional		$76.13	$94.28	$137.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.60 / $27.27 / $39.00	Professional	26	$21.60	$27.27	$39.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.03 / $66.76 / $99.74	Professional	TC	$56.03	$66.76	$99.74