Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $9.33 / $9.33 / $13.49	Facility		$9.33	$9.33	$13.49
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $12.30 / $12.30 / $13.49	Facility	TC	$12.30	$12.30	$13.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $19.05 / $52.48	Professional		$13.80	$19.05	$52.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $25.70 / $79.43	Professional	26	$8.91	$25.70	$79.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $5.25 / $7.08 / $19.95	Professional	TC	$5.25	$7.08	$19.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $19.95	Professional		$19.95	$19.95	$19.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $11.75 / $15.49	Professional	26	$5.62	$11.75	$15.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $32.36 / $32.36	Professional		$17.78	$32.36	$32.36
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.05 / $25.70	Professional	26	$19.05	$19.05	$25.70
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $13.18 / $13.18 / $17.78	Professional	TC	$13.18	$13.18	$17.78
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.41 / $19.95 / $48.98	Facility		$7.41	$19.95	$48.98
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $16.98 / $28.18	Professional		$9.12	$16.98	$28.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $17.38 / $17.38 / $20.89	Facility		$17.38	$17.38	$20.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $17.78 / $79.43	Professional		$9.77	$17.78	$79.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $16.60 / $45.71	Professional	26	$6.17	$16.60	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3.55 / $4.68 / $18.62	Professional	TC	$3.55	$4.68	$18.62
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $9.33 / $9.33 / $13.49	Facility		$9.33	$9.33	$13.49
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $13.49 / $13.49 / $13.49	Facility	TC	$13.49	$13.49	$13.49
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $23.44 / $44.67	Professional		$15.85	$23.44	$44.67
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.85 / $70.79	Professional	26	$10.00	$15.85	$70.79
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $6.03 / $9.33 / $15.49	Professional	TC	$6.03	$9.33	$15.49
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $17.38 / $17.38 / $20.89	Facility		$17.38	$17.38	$20.89
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $10.47 / $29.51	Professional		$8.71	$10.47	$29.51
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.25 / $6.31 / $17.38	Professional	26	$5.25	$6.31	$17.38
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $3.55 / $4.17 / $11.75	Professional	TC	$3.55	$4.17	$11.75
United Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $19.05 / $30.90	Professional		$11.48	$19.05	$30.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.02 / $18.20	Professional	26	$7.59	$12.02	$18.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $3.98 / $6.92 / $11.75	Professional	TC	$3.98	$6.92	$11.75