Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.28 / $21.28 / $22.34	Facility	26	$21.28	$21.28	$22.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.89 / $113.59 / $166.58	Professional		$89.89	$113.59	$166.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.32 / $21.28 / $49.12	Professional	26	$16.32	$21.28	$49.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.44 / $92.31 / $143.35	Professional	TC	$73.44	$92.31	$143.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.06 / $122.46 / $122.46	Professional		$72.06	$122.46	$122.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.59 / $23.89 / $34.18	Professional	26	$14.59	$23.89	$34.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.89 / $144.91 / $173.90	Professional		$26.89	$144.91	$173.90
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.45 / $28.76 / $28.76	Professional	26	$24.45	$28.76	$28.76
CareSource Facility/Professional Professional Modifier Low / Median / High Price $18.14 / $87.04 / $122.73	Professional		$18.14	$87.04	$122.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.50 / $20.50 / $20.50	Facility	26	$20.50	$20.50	$20.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.48 / $113.47 / $209.63	Professional		$68.48	$113.47	$209.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.16 / $22.12 / $39.18	Professional	26	$14.16	$22.12	$39.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.10 / $84.61 / $171.55	Professional	TC	$55.10	$84.61	$171.55
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $15.16 / $21.28 / $26.81	Facility	26	$15.16	$21.28	$26.81
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $93.69 / $113.59 / $173.19	Professional		$93.69	$113.59	$173.19
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $15.16 / $21.28 / $47.05	Professional	26	$15.16	$21.28	$47.05
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $78.54 / $92.31 / $139.84	Professional	TC	$78.54	$92.31	$139.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $53.61 / $66.11 / $92.03	Professional		$53.61	$66.11	$92.03
United Facility/Professional Professional Modifier Low / Median / High Price $81.42 / $97.80 / $146.69	Professional		$81.42	$97.80	$146.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.32 / $20.28 / $31.33	Professional	26	$16.32	$20.28	$31.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.28 / $78.67 / $128.37	Professional	TC	$61.28	$78.67	$128.37