Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.39 / $10.39 / $13.09	Facility	26	$10.39	$10.39	$13.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.93 / $58.97 / $95.42	Professional		$51.93	$58.97	$95.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.45 / $9.07 / $22.03	Professional	26	$7.45	$9.07	$22.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.34 / $28.78 / $32.47	Professional	52	$24.34	$28.78	$32.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.06 / $50.03 / $71.48	Professional	TC	$43.06	$50.03	$71.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.77 / $53.06 / $90.71	Professional		$45.77	$53.06	$90.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.55 / $9.90 / $14.92	Professional	26	$7.55	$9.90	$14.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.40 / $38.40 / $38.40	Professional	TC	$38.40	$38.40	$38.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.95 / $76.06 / $93.06	Professional		$12.95	$76.06	$93.06
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $13.85 / $13.85	Professional	26	$11.77	$13.85	$13.85
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.29 / $64.29 / $75.63	Professional	TC	$64.29	$64.29	$75.63
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.71 / $54.44 / $70.92	Professional		$9.71	$54.44	$70.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.65 / $71.75 / $203.14	Professional		$52.65	$71.75	$203.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $11.55 / $29.87	Professional	26	$8.56	$11.55	$29.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.26 / $60.85 / $173.27	Professional	TC	$44.26	$60.85	$173.27
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $8.10 / $10.39 / $13.09	Facility	26	$8.10	$10.39	$13.09
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $51.89 / $63.42 / $95.42	Professional		$51.89	$63.42	$95.42
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $8.10 / $10.39 / $18.48	Professional	26	$8.10	$10.39	$18.48
Health Alliance Plan Facility/Professional Professional Modifier 52 Low / Median / High Price $26.10 / $31.10 / $36.08	Professional	52	$26.10	$31.10	$36.08
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $43.79 / $53.03 / $70.01	Professional	TC	$43.79	$53.03	$70.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.80 / $33.15 / $47.38	Professional		$26.80	$33.15	$47.38
United Facility/Professional Professional Modifier Low / Median / High Price $48.87 / $61.66 / $96.58	Professional		$48.87	$61.66	$96.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.97 / $9.99 / $15.08	Professional	26	$7.97	$9.99	$15.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.67 / $51.52 / $73.78	Professional	TC	$42.67	$51.52	$73.78