Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.34 / $135.16 / $238.00	Facility		$48.34	$135.16	$238.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $35.08 / $35.08 / $70.17	Facility	TC	$35.08	$35.08	$70.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.44 / $37.97 / $72.05	Professional		$27.44	$37.97	$72.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.18 / $13.84 / $55.14	Professional	26	$9.18	$13.84	$55.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.50 / $38.77 / $56.60	Professional	TC	$25.50	$38.77	$56.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.26 / $20.71 / $41.42	Professional		$19.26	$20.71	$41.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.44 / $10.44 / $14.14	Professional	26	$5.44	$10.44	$14.14
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.94 / $52.62 / $68.20	Professional		$44.94	$52.62	$68.20
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.19 / $13.19 / $17.57	Professional	26	$13.19	$13.19	$17.57
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.95 / $37.95 / $50.60	Professional	TC	$37.95	$37.95	$50.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $12.48 / $38.43 / $64.72	Facility		$12.48	$38.43	$64.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.40 / $33.59 / $70.80	Professional		$10.40	$33.59	$70.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.54 / $41.73 / $102.06	Professional		$19.54	$41.73	$102.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.03 / $10.45 / $39.00	Professional	26	$5.03	$10.45	$39.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.73 / $19.19 / $51.75	Professional	TC	$13.73	$19.19	$51.75
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $48.34 / $48.34 / $48.34	Facility		$48.34	$48.34	$48.34
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $35.08 / $50.75 / $70.17	Facility	TC	$35.08	$50.75	$70.17
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $35.15 / $53.31 / $73.00	Professional		$35.15	$53.31	$73.00
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.35 / $13.84 / $128.25	Professional	26	$10.35	$13.84	$128.25
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $27.62 / $40.00 / $55.06	Professional	TC	$27.62	$40.00	$55.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $32.34 / $40.96	Professional		$26.31	$32.34	$40.96
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $46.05 / $65.61	Professional		$25.12	$46.05	$65.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $10.68 / $16.67	Professional	26	$6.92	$10.68	$16.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.97 / $33.84 / $49.61	Professional	TC	$17.97	$33.84	$49.61