Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.75 / $8.75 / $11.03	Facility	26	$8.75	$8.75	$11.03
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.00 / $17.87 / $195.29	Facility	TC	$16.00	$17.87	$195.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.21 / $24.76 / $37.90	Professional		$20.21	$24.76	$37.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.42 / $8.13 / $18.95	Professional	26	$6.42	$8.13	$18.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.08 / $16.44 / $26.52	Professional	TC	$13.08	$16.44	$26.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.09 / $21.29 / $24.04	Professional		$18.09	$21.29	$24.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.72 / $7.85 / $14.00	Professional	26	$5.72	$7.85	$14.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $13.95 / $13.95 / $19.52	Professional	TC	$13.95	$13.95	$19.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.51 / $32.36 / $71.20	Professional		$11.51	$32.36	$71.20
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.96 / $11.72 / $11.72	Professional	26	$9.96	$11.72	$11.72
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $58.85 / $69.23 / $69.23	Professional	50	$58.85	$69.23	$69.23
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.47 / $22.90 / $22.90	Professional	TC	$19.47	$22.90	$22.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.82 / $16.48 / $27.47	Professional		$7.82	$16.48	$27.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.46 / $8.46 / $8.46	Facility	26	$8.46	$8.46	$8.46
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $16.03 / $16.03 / $16.03	Facility	TC	$16.03	$16.03	$16.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $18.89 / $29.40 / $47.52	Professional		$18.89	$29.40	$47.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.78 / $9.38 / $18.17	Professional	26	$5.78	$9.38	$18.17
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $26.27 / $34.43 / $35.84	Professional	50	$26.27	$34.43	$35.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.11 / $20.20 / $37.49	Professional	TC	$13.11	$20.20	$37.49
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $6.02 / $8.75 / $9.19	Facility	26	$6.02	$8.75	$9.19
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $16.00 / $24.00 / $111.60	Facility	TC	$16.00	$24.00	$111.60
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $19.46 / $24.76 / $39.94	Professional		$19.46	$24.76	$39.94
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.02 / $8.75 / $15.63	Professional	26	$6.02	$8.75	$15.63
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $13.44 / $16.00 / $26.68	Professional	TC	$13.44	$16.00	$26.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $4.69 / $13.85 / $100.00	Professional		$4.69	$13.85	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $20.56 / $24.92 / $36.20	Professional		$20.56	$24.92	$36.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.68 / $8.16 / $12.72	Professional	26	$6.68	$8.16	$12.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $13.02 / $16.25 / $22.92	Professional	TC	$13.02	$16.25	$22.92