Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.10 / $15.10 / $15.10	Facility	26	$15.10	$15.10	$15.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.89 / $117.91 / $177.69	Professional		$90.89	$117.91	$177.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $15.10 / $51.30	Professional	26	$11.77	$15.10	$51.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.11 / $102.81 / $164.23	Professional	TC	$79.11	$102.81	$164.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.31 / $114.31 / $114.31	Professional		$114.31	$114.31	$114.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $20.04 / $149.38 / $178.16	Professional		$20.04	$149.38	$178.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.29 / $164.38 / $290.18	Professional		$89.29	$164.38	$290.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.83 / $13.88 / $28.83	Professional	26	$8.83	$13.88	$28.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.12 / $144.34 / $256.86	Professional	TC	$77.12	$144.34	$256.86
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $9.46 / $9.46 / $15.10	Facility	26	$9.46	$9.46	$15.10
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $92.58 / $116.58 / $184.58	Professional		$92.58	$116.58	$184.58
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.46 / $12.55 / $19.61	Professional	26	$9.46	$12.55	$19.61
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $82.07 / $107.11 / $166.62	Professional	TC	$82.07	$107.11	$166.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $78.52 / $97.84 / $133.91	Professional		$78.52	$97.84	$133.91
United Facility/Professional Professional Modifier Low / Median / High Price $106.12 / $139.31 / $204.09	Professional		$106.12	$139.31	$204.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.97 / $12.79 / $20.30	Professional	26	$10.97	$12.79	$20.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.83 / $114.57 / $181.91	Professional	TC	$93.83	$114.57	$181.91