Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $117.49 / $302.00	Facility		$36.31	$117.49	$302.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $13.80 / $18.62	Facility	26	$11.48	$13.80	$18.62
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.39 / $181.97 / $436.52	Facility	TC	$22.39	$181.97	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $38.02 / $104.71	Professional		$25.12	$38.02	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $13.80 / $38.90	Professional	26	$8.91	$13.80	$38.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $22.39 / $63.10	Professional	TC	$17.38	$22.39	$63.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $26.92 / $52.48	Professional		$19.95	$26.92	$52.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $10.72 / $16.98	Professional	26	$7.76	$10.72	$16.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $20.89 / $36.31	Professional	TC	$15.14	$20.89	$36.31
BCBS Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $75.86 / $104.71	Facility		$75.86	$75.86	$104.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $34.67 / $44.67	Professional		$30.20	$34.67	$44.67
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $12.88 / $16.60	Professional	26	$11.22	$12.88	$16.60
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $21.88 / $28.18	Professional	TC	$19.05	$21.88	$28.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.47 / $30.20 / $50.12	Facility		$10.47	$30.20	$50.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $24.55 / $48.98	Professional		$10.23	$24.55	$48.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $107.15 / $229.09	Facility		$22.39	$107.15	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $40.74 / $64.57	Professional		$28.84	$40.74	$64.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.79 / $22.39	Professional	26	$10.00	$14.79	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $25.12 / $42.66	Professional	TC	$18.20	$25.12	$42.66
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $57.54 / $64.57	Professional		$36.31	$57.54	$64.57
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $19.05 / $21.88	Professional	26	$13.18	$19.05	$21.88
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $28.84 / $39.81	Professional	TC	$23.44	$28.84	$39.81
United Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $138.04 / $257.04	Facility		$107.15	$138.04	$257.04
United Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $33.88 / $58.88	Professional		$28.84	$33.88	$58.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $12.30 / $20.89	Professional	26	$9.77	$12.30	$20.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $21.88 / $38.02	Professional	TC	$17.78	$21.88	$38.02