Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.04 / $4.04 / $5.09	Facility	26	$4.04	$4.04	$5.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.92 / $38.21 / $114.60	Professional		$25.92	$38.21	$114.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.17 / $4.24 / $14.99	Professional	26	$3.17	$4.24	$14.99
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $7.94 / $14.73 / $16.41	Professional	52	$7.94	$14.73	$16.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.49 / $32.02 / $51.15	Professional	TC	$23.49	$32.02	$51.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $18.47 / $21.73	Professional		$17.38	$18.47	$21.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $2.47 / $3.78 / $3.96	Professional	26	$2.47	$3.78	$3.96
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	TC	$33.88	$33.88	$33.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $4.48 / $32.68 / $45.72	Professional		$4.48	$32.68	$45.72
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $4.07 / $4.79 / $4.79	Professional	26	$4.07	$4.79	$4.79
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.71 / $31.42 / $31.42	Professional	TC	$26.71	$31.42	$31.42
CareSource Facility/Professional Professional Modifier Low / Median / High Price $3.25 / $20.46 / $27.62	Professional		$3.25	$20.46	$27.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.49 / $3.49 / $3.49	Facility	26	$3.49	$3.49	$3.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.02 / $35.33 / $126.00	Professional		$24.02	$35.33	$126.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.17 / $4.65 / $8.97	Professional	26	$3.17	$4.65	$8.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.48 / $32.40 / $120.96	Professional	TC	$21.48	$32.40	$120.96
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $3.85 / $4.04 / $4.59	Facility	26	$3.85	$4.04	$4.59
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $24.21 / $31.98 / $111.81	Professional		$24.21	$31.98	$111.81
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $3.05 / $4.11 / $14.55	Professional	26	$3.05	$4.11	$14.55
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $5.29 / $14.73 / $22.66	Professional	52	$5.29	$14.73	$22.66
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.73 / $25.42 / $39.28	Professional	TC	$21.73	$25.42	$39.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $33.64 / $48.31	Professional		$26.52	$33.64	$48.31
United Facility/Professional Professional Modifier Low / Median / High Price $25.10 / $32.95 / $107.51	Professional		$25.10	$32.95	$107.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.25 / $4.16 / $6.11	Professional	26	$3.25	$4.16	$6.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.72 / $29.03 / $90.56	Professional	TC	$21.72	$29.03	$90.56