Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $34.15 / $131.47 / $511.06	Facility		$34.15	$131.47	$511.06
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.91 / $16.91 / $113.81	Facility	26	$16.91	$16.91	$113.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.91 / $42.45 / $63.67	Professional		$30.91	$42.45	$63.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.82 / $16.91 / $39.65	Professional	26	$12.82	$16.91	$39.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $26.96 / $43.00	Professional	TC	$17.89	$26.96	$43.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.85 / $37.54 / $37.54	Professional		$28.85	$37.54	$37.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $14.33 / $24.12	Professional	26	$10.72	$14.33	$24.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $45.73 / $83.29 / $165.98	Facility		$45.73	$83.29	$165.98
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.90 / $77.31 / $127.40	Professional		$23.90	$77.31	$127.40
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 $39.95 / $39.95 / $39.95	Professional	TC	$39.95	$39.95	$39.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $13.40 / $27.68 / $48.82	Facility		$13.40	$27.68	$48.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.26 / $28.78 / $46.75	Professional		$14.26	$28.78	$46.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $42.87 / $42.87 / $42.87	Facility		$42.87	$42.87	$42.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.88 / $15.88 / $15.88	Facility	26	$15.88	$15.88	$15.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.22 / $44.76 / $80.77	Professional		$29.22	$44.76	$80.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.98 / $18.67 / $34.11	Professional	26	$10.98	$18.67	$34.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.95 / $25.59 / $56.27	Professional	TC	$16.95	$25.59	$56.27
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $40.58 / $174.07 / $540.54	Facility		$40.58	$174.07	$540.54
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.25 / $16.91 / $19.43	Facility	26	$12.25	$16.91	$19.43
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $28.33 / $45.07 / $59.96	Professional		$28.33	$45.07	$59.96
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $12.25 / $16.91 / $38.22	Professional	26	$12.25	$16.91	$38.22
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.07 / $28.14 / $37.38	Professional	TC	$16.07	$28.14	$37.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $33.44 / $48.19	Professional		$26.52	$33.44	$48.19
United Facility/Professional Professional Modifier Low / Median / High Price $33.22 / $39.09 / $49.98	Professional		$33.22	$39.09	$49.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.70 / $16.38 / $22.42	Professional	26	$13.70	$16.38	$22.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.01 / $22.37 / $29.56	Professional	TC	$19.01	$22.37	$29.56