Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $9.12 / $11.48	Facility	26	$9.12	$9.12	$11.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $38.90 / $114.82	Professional		$18.20	$38.90	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $12.88 / $40.74	Professional	26	$6.31	$12.88	$40.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.48 / $131.83 / $275.42	Professional	50	$52.48	$131.83	$275.42
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.38 / $54.95 / $107.15	Professional	52	$21.38	$54.95	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $24.55 / $57.54	Professional	TC	$15.85	$24.55	$57.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $22.39 / $27.54	Professional		$10.00	$22.39	$27.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $7.59 / $12.88	Professional	26	$7.08	$7.59	$12.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $31.62 / $31.62 / $31.62	Professional	50	$31.62	$31.62	$31.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $18.20 / $19.05	Professional	TC	$16.98	$18.20	$19.05
BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $45.71 / $85.11	Professional		$30.90	$45.71	$85.11
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $12.30 / $16.60	Professional	26	$12.30	$12.30	$16.60
BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $91.20 / $91.20 / $123.03	Professional	50	$91.20	$91.20	$123.03
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $33.11 / $33.11	Professional	TC	$28.18	$33.11	$33.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $23.44 / $39.81	Professional		$8.51	$23.44	$39.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $37.15 / $75.86	Professional		$22.91	$37.15	$75.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.72 / $22.39	Professional	26	$6.46	$10.72	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $27.54 / $60.26	Professional	TC	$16.98	$27.54	$60.26
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $9.33 / $16.98	Facility	26	$8.91	$9.33	$16.98
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $35.48 / $87.10	Professional		$22.91	$35.48	$87.10
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $10.00 / $27.54	Professional	26	$6.31	$10.00	$27.54
Health Alliance Plan Facility/Professional Professional Modifier 50 Low / Median / High Price $48.98 / $114.82 / $275.42	Professional	50	$48.98	$114.82	$275.42
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $21.38 / $54.95 / $107.15	Professional	52	$21.38	$54.95	$107.15
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $23.99 / $45.71	Professional	TC	$16.98	$23.99	$45.71
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $29.51 / $64.57	Professional		$21.88	$29.51	$64.57
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $9.12 / $19.95	Professional	26	$5.62	$9.12	$19.95
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $20.89 / $56.23	Professional	TC	$15.85	$20.89	$56.23
United Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $28.84 / $43.65	Professional		$24.55	$28.84	$43.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $8.51 / $13.18	Professional	26	$7.24	$8.51	$13.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $20.42 / $30.90	Professional	TC	$16.98	$20.42	$30.90