Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $9.38 / $9.38 / $77.91	Facility		$9.38	$9.38	$77.91
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $95.67 / $95.67 / $95.67	Facility	TC	$95.67	$95.67	$95.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.21 / $79.23 / $115.30	Professional		$42.21	$79.23	$115.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.58 / $20.27 / $60.80	Professional	26	$10.58	$20.27	$60.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.70 / $75.42 / $129.96	Professional	TC	$46.70	$75.42	$129.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.68 / $36.68 / $79.06	Professional		$36.68	$36.68	$79.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.69 / $11.53 / $15.57	Professional	26	$5.69	$11.53	$15.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.13 / $31.13 / $91.17	Professional	TC	$31.13	$31.13	$91.17
BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.27 / $122.50 / $165.38	Professional		$98.27	$122.50	$165.38
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.98 / $13.98 / $18.64	Professional	26	$13.98	$13.98	$18.64
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.29 / $84.29 / $112.38	Professional	TC	$84.29	$84.29	$112.38
CareSource Facility/Professional Facility Modifier Low / Median / High Price $13.25 / $73.26 / $122.45	Facility		$13.25	$73.26	$122.45
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.04 / $73.26 / $156.57	Professional		$11.04	$73.26	$156.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.22 / $60.19 / $134.01	Professional		$35.22	$60.19	$134.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.32 / $11.13 / $49.50	Professional	26	$5.32	$11.13	$49.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.79 / $35.53 / $95.39	Professional	TC	$24.79	$35.53	$95.39
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $9.38 / $9.38 / $77.91	Facility		$9.38	$9.38	$77.91
Health Alliance Plan Facility/Professional Facility Modifier TC Low / Median / High Price $77.91 / $112.73 / $287.00	Facility	TC	$77.91	$112.73	$287.00
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $55.83 / $82.68 / $123.33	Professional		$55.83	$82.68	$123.33
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.20 / $14.71 / $64.59	Professional	26	$11.20	$14.71	$64.59
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $52.29 / $70.95 / $114.80	Professional	TC	$52.29	$70.95	$114.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.40 / $64.69 / $81.31	Professional		$52.40	$64.69	$81.31
United Facility/Professional Professional Modifier Low / Median / High Price $44.92 / $65.78 / $108.12	Professional		$44.92	$65.78	$108.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.37 / $11.36 / $20.25	Professional	26	$7.37	$11.36	$20.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.54 / $53.86 / $90.44	Professional	TC	$37.54	$53.86	$90.44