Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.67 / $16.67 / $21.01	Facility	26	$16.67	$16.67	$21.01
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $44.14 / $66.23 / $241.35	Facility	TC	$44.14	$66.23	$241.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.27 / $60.82 / $97.00	Professional		$44.27	$60.82	$97.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.30 / $16.67 / $41.80	Professional	26	$13.30	$16.67	$41.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $44.15 / $74.20	Professional	TC	$30.85	$44.15	$74.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.13 / $52.30 / $60.82	Professional		$40.13	$52.30	$60.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.64 / $13.79 / $21.50	Professional	26	$10.64	$13.79	$21.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $54.24 / $54.24 / $54.24	Professional	TC	$54.24	$54.24	$54.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $20.92 / $68.72 / $96.80	Professional		$20.92	$68.72	$96.80
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.01 / $22.37 / $22.37	Professional	26	$19.01	$22.37	$22.37
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.32 / $63.91 / $63.91	Professional	TC	$54.32	$63.91	$63.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.04 / $46.02 / $68.75	Professional		$15.04	$46.02	$68.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.18 / $59.71 / $115.81	Professional		$40.18	$59.71	$115.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.31 / $17.96 / $34.43	Professional	26	$11.31	$17.96	$34.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.27 / $43.04 / $84.66	Professional	TC	$30.27	$43.04	$84.66
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $11.63 / $16.67 / $17.51	Facility	26	$11.63	$16.67	$17.51
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $44.14 / $81.68 / $308.08	Facility	TC	$44.14	$81.68	$308.08
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $60.82 / $97.00	Professional		$36.65	$60.82	$97.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.63 / $16.67 / $35.01	Professional	26	$11.63	$16.67	$35.01
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $25.02 / $44.14 / $69.26	Professional	TC	$25.02	$44.14	$69.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $33.09 / $47.38	Professional		$26.52	$33.09	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $44.79 / $52.69 / $76.68	Professional		$44.79	$52.69	$76.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.65 / $16.36 / $24.86	Professional	26	$13.65	$16.36	$24.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.23 / $36.47 / $51.79	Professional	TC	$30.23	$36.47	$51.79