Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $12.59	Facility	26	$10.00	$10.00	$12.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $47.86 / $112.20	Professional		$30.20	$47.86	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.72 / $29.51	Professional	26	$7.08	$10.72	$29.51
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.90 / $40.74 / $54.95	Professional	50	$38.90	$40.74	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $33.11 / $72.44	Professional	TC	$22.39	$33.11	$72.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $33.11 / $51.29	Professional		$25.12	$33.11	$51.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $7.76 / $15.85	Professional	26	$6.92	$7.76	$15.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $22.39 / $22.39	Professional	TC	$22.39	$22.39	$22.39
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $60.26 / $64.57	Professional		$46.77	$60.26	$64.57
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $13.18 / $17.78	Professional	26	$13.18	$13.18	$17.78
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $50.12 / $50.12	Professional	TC	$42.66	$50.12	$50.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $34.67 / $54.95	Professional		$9.12	$34.67	$54.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $46.77 / $107.15	Professional		$29.51	$46.77	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $12.02 / $24.55	Professional	26	$7.24	$12.02	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $38.90 / $91.20	Professional	TC	$21.38	$38.90	$91.20
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $10.00 / $23.99	Facility	26	$8.91	$10.00	$23.99
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $45.71 / $91.20	Professional		$30.20	$45.71	$91.20
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $10.23 / $22.91	Professional	26	$7.76	$10.23	$22.91
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $38.90 / $38.90 / $40.74	Professional	50	$38.90	$38.90	$40.74
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $34.67 / $64.57	Professional	TC	$21.88	$34.67	$64.57
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $36.31 / $85.11	Professional		$27.54	$36.31	$85.11
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $10.23 / $22.39	Professional	26	$6.03	$10.23	$22.39
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $29.51 / $87.10	Professional	TC	$19.95	$29.51	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $38.02 / $58.88	Professional		$30.20	$38.02	$58.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $9.55 / $14.79	Professional	26	$8.13	$9.55	$14.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.84 / $45.71	Professional	TC	$20.42	$28.84	$45.71