Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.50 / $14.50 / $18.28	Facility	26	$14.50	$14.50	$18.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.75 / $110.92 / $194.71	Professional		$76.75	$110.92	$194.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $14.50 / $44.87	Professional	26	$11.34	$14.50	$44.87
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.93 / $46.22 / $89.93	Professional	52	$37.93	$46.22	$89.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.90 / $98.19 / $162.66	Professional	TC	$73.90	$98.19	$162.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.67 / $67.54 / $98.77	Professional		$60.67	$67.54	$98.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.77 / $11.29 / $17.87	Professional	26	$8.77	$11.29	$17.87
BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.43 / $116.32 / $152.51	Professional		$17.43	$116.32	$152.51
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.84 / $18.64 / $18.64	Professional	26	$15.84	$18.64	$18.64
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.07 / $111.85 / $111.85	Professional	TC	$95.07	$111.85	$111.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $12.32 / $73.11 / $99.48	Professional		$12.32	$73.11	$99.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.54 / $13.54 / $13.54	Facility	26	$13.54	$13.54	$13.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.20 / $109.67 / $235.70	Professional		$74.20	$109.67	$235.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $14.96 / $32.88	Professional	26	$11.78	$14.96	$32.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.45 / $97.53 / $200.92	Professional	TC	$68.45	$97.53	$200.92
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $11.70 / $14.50 / $18.28	Facility	26	$11.70	$14.50	$18.28
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $78.13 / $100.66 / $160.34	Professional		$78.13	$100.66	$160.34
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.50 / $14.50 / $33.97	Professional	26	$11.50	$14.50	$33.97
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $39.56 / $46.22 / $132.00	Professional	52	$39.56	$46.22	$132.00
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $74.45 / $88.95 / $131.53	Professional	TC	$74.45	$88.95	$131.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $53.04 / $67.28 / $96.63	Professional		$53.04	$67.28	$96.63
United Facility/Professional Professional Modifier Low / Median / High Price $86.62 / $108.80 / $158.81	Professional		$86.62	$108.80	$158.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $13.93 / $20.82	Professional	26	$11.69	$13.93	$20.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.63 / $97.96 / $134.10	Professional	TC	$73.63	$97.96	$134.10