Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.95 / $7.95 / $8.34	Facility	26	$7.95	$7.95	$8.34
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.89 / $36.63 / $168.48	Facility	TC	$34.89	$36.63	$168.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.41 / $44.85 / $116.85	Professional		$28.41	$44.85	$116.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.84 / $7.95 / $29.76	Professional	26	$5.84	$7.95	$29.76
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $156.44 / $156.44 / $156.44	Professional	50	$156.44	$156.44	$156.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.57 / $21.42 / $21.42	Professional	52	$12.57	$21.42	$21.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $34.89 / $75.70	Professional	TC	$22.57	$34.89	$75.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.45 / $34.43 / $48.39	Professional		$28.45	$34.43	$48.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.08 / $6.35 / $12.60	Professional	26	$5.08	$6.35	$12.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.54 / $50.54 / $50.54	Professional	TC	$30.54	$50.54	$50.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.96 / $57.27 / $127.40	Professional		$9.96	$57.27	$127.40
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.05 / $10.65 / $10.65	Professional	26	$9.05	$10.65	$10.65
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $104.13 / $122.50 / $122.50	Professional	50	$104.13	$122.50	$122.50
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.01 / $50.60 / $50.60	Professional	TC	$43.01	$50.60	$50.60
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.07 / $34.34 / $48.42	Professional		$7.07	$34.34	$48.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.66 / $7.66 / $7.66	Facility	26	$7.66	$7.66	$7.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Facility	TC	$35.40	$35.40	$35.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.85 / $40.01 / $81.56	Professional		$25.85	$40.01	$81.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.29 / $8.32 / $16.48	Professional	26	$5.29	$8.32	$16.48
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.70 / $43.71 / $49.70	Professional	50	$30.70	$43.71	$49.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.43 / $32.40 / $66.95	Professional	TC	$18.43	$32.40	$66.95
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $5.49 / $7.95 / $8.34	Facility	26	$5.49	$7.95	$8.34
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $34.89 / $48.85 / $244.32	Facility	TC	$34.89	$48.85	$244.32
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $26.61 / $43.42 / $92.96	Professional		$26.61	$43.42	$92.96
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $5.49 / $7.95 / $21.01	Professional	26	$5.49	$7.95	$21.01
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $16.30 / $21.42 / $52.23	Professional	52	$16.30	$21.42	$52.23
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.11 / $34.89 / $59.46	Professional	TC	$21.11	$34.89	$59.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $33.09 / $47.38	Professional		$26.31	$33.09	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $25.65 / $34.29 / $49.19	Professional		$25.65	$34.29	$49.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.14 / $7.48 / $11.50	Professional	26	$6.14	$7.48	$11.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.34 / $27.43 / $37.94	Professional	TC	$19.34	$27.43	$37.94