Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $13.18 / $16.60	Facility	26	$13.18	$13.18	$16.60
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $53.70 / $218.78	Facility	TC	$28.84	$53.70	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $46.77 / $144.54	Professional		$30.20	$46.77	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $17.78 / $52.48	Professional	26	$10.00	$17.78	$52.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.84 / $70.79	Professional	TC	$19.05	$28.84	$70.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $30.90 / $46.77	Professional		$24.55	$30.90	$46.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $10.47 / $17.78	Professional	26	$9.33	$10.47	$17.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $28.18 / $32.36	Professional	TC	$21.38	$28.18	$32.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $54.95 / $58.88	Professional		$50.12	$54.95	$58.88
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $17.38 / $17.38	Professional	26	$17.38	$17.38	$17.38
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $41.69 / $41.69	Professional	TC	$35.48	$41.69	$41.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $29.51 / $52.48	Professional		$12.30	$29.51	$52.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $18.20	Facility	26	$2.69	$12.59	$18.20
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.03 / $28.18 / $40.74	Facility	TC	$6.03	$28.18	$40.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $45.71 / $100.00	Professional		$28.18	$45.71	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $15.49 / $32.36	Professional	26	$9.33	$15.49	$32.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $33.88 / $74.13	Professional	TC	$19.95	$33.88	$74.13
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $13.18 / $23.44	Facility	26	$13.18	$13.18	$23.44
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $53.70 / $229.09	Facility	TC	$28.84	$53.70	$229.09
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $41.69 / $104.71	Professional		$28.18	$41.69	$104.71
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.79 / $43.65	Professional	26	$10.00	$14.79	$43.65
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $28.84 / $58.88	Professional	TC	$18.20	$28.84	$58.88
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $18.20	Facility	26	$2.69	$12.59	$18.20
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $6.03 / $28.18 / $40.74	Facility	TC	$6.03	$28.18	$40.74
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $35.48 / $79.43	Professional		$26.92	$35.48	$79.43
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $12.59 / $28.84	Professional	26	$8.51	$12.59	$28.84
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $25.70 / $70.79	Professional	TC	$17.78	$25.70	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $36.31 / $54.95	Professional		$30.90	$36.31	$54.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $12.59 / $19.05	Professional	26	$10.47	$12.59	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $23.99 / $37.15	Professional	TC	$19.95	$23.99	$37.15