Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.97 / $13.97 / $17.60	Facility	26	$13.97	$13.97	$17.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.79 / $56.79 / $95.83	Professional		$49.79	$56.79	$95.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.93 / $13.17 / $33.21	Professional	26	$10.93	$13.17	$33.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.43 / $27.42 / $31.38	Professional	52	$23.43	$27.42	$31.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.52 / $45.31 / $63.39	Professional	TC	$38.52	$45.31	$63.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.38 / $55.07 / $102.08	Professional		$46.38	$55.07	$102.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.14 / $12.28 / $20.53	Professional	26	$10.14	$12.28	$20.53
BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.43 / $76.95 / $97.35	Professional		$17.43	$76.95	$97.35
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 $61.12 / $61.12 / $71.90	Professional	TC	$61.12	$61.12	$71.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $13.14 / $51.82 / $71.81	Professional		$13.14	$51.82	$71.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.66 / $71.34 / $204.33	Professional		$50.66	$71.34	$204.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.61 / $16.35 / $40.63	Professional	26	$11.61	$16.35	$40.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.85 / $55.84 / $163.71	Professional	TC	$39.85	$55.84	$163.71
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $12.03 / $13.97 / $17.60	Facility	26	$12.03	$13.97	$17.60
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $51.90 / $61.15 / $94.65	Professional		$51.90	$61.15	$94.65
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.35 / $13.97 / $27.27	Professional	26	$11.35	$13.97	$27.27
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $24.93 / $30.29 / $34.64	Professional	52	$24.93	$30.29	$34.64
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $40.44 / $47.17 / $62.27	Professional	TC	$40.44	$47.17	$62.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.80 / $33.15 / $47.38	Professional		$26.80	$33.15	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $50.72 / $61.58 / $103.45	Professional		$50.72	$61.58	$103.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.37 / $14.16 / $20.34	Professional	26	$11.37	$14.16	$20.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.47 / $46.06 / $66.56	Professional	TC	$38.47	$46.06	$66.56