Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.58 / $7.58 / $7.95	Facility	26	$7.58	$7.58	$7.95
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.62 / $28.68 / $203.62	Facility	TC	$25.62	$28.68	$203.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $33.97 / $82.53	Professional		$26.17	$33.97	$82.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.53 / $7.58 / $17.82	Professional	26	$5.53	$7.58	$17.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $25.63 / $45.29	Professional	TC	$20.96	$25.63	$45.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.64 / $24.05 / $52.78	Professional		$21.64	$24.05	$52.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $4.96 / $6.18 / $12.12	Professional	26	$4.96	$6.18	$12.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.92 / $21.92 / $21.92	Professional	TC	$21.92	$21.92	$21.92
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.46 / $46.34 / $95.33	Professional		$9.46	$46.34	$95.33
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.60 / $10.11 / $10.11	Professional	26	$8.60	$10.11	$10.11
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.79 / $36.22 / $36.22	Professional	TC	$30.79	$36.22	$36.22
CareSource Facility/Professional Professional Modifier Low / Median / High Price $6.73 / $25.18 / $36.65	Professional		$6.73	$25.18	$36.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.31 / $7.31 / $7.31	Facility	26	$7.31	$7.31	$7.31
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $25.73 / $25.73 / $25.73	Facility	TC	$25.73	$25.73	$25.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.90 / $33.18 / $61.73	Professional		$23.90	$33.18	$61.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $8.02 / $15.74	Professional	26	$5.01	$8.02	$15.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.19 / $27.53 / $54.89	Professional	TC	$18.19	$27.53	$54.89
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $5.23 / $7.58 / $7.95	Facility	26	$5.23	$7.58	$7.95
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $25.62 / $38.45 / $175.36	Facility	TC	$25.62	$38.45	$175.36
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $24.22 / $33.20 / $63.34	Professional		$24.22	$33.20	$63.34
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $5.23 / $7.58 / $15.50	Professional	26	$5.23	$7.58	$15.50
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.98 / $25.63 / $42.43	Professional	TC	$18.98	$25.63	$42.43
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 $24.38 / $29.17 / $43.73	Professional		$24.38	$29.17	$43.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.83 / $7.05 / $10.91	Professional	26	$5.83	$7.05	$10.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.39 / $21.90 / $32.72	Professional	TC	$18.39	$21.90	$32.72