Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $141.25 / $416.87	Facility		$39.81	$141.25	$416.87
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $14.79 / $17.38	Facility	26	$14.13	$14.79	$17.38
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $31.62 / $263.03	Facility	TC	$25.70	$31.62	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $38.02 / $93.33	Professional		$24.55	$38.02	$93.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.18 / $33.11	Professional	26	$7.94	$13.18	$33.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $23.99 / $50.12	Professional	TC	$16.98	$23.99	$50.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $28.84 / $50.12	Professional		$20.89	$28.84	$50.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.47 / $16.98	Professional	26	$7.41	$10.47	$16.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $20.42 / $37.15	Professional	TC	$16.98	$20.42	$37.15
BCBS Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $147.91	Facility		$107.15	$107.15	$147.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $39.81 / $51.29	Professional		$34.67	$39.81	$51.29
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $14.13 / $18.20	Professional	26	$12.30	$14.13	$18.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $25.70 / $33.11	Professional	TC	$22.39	$25.70	$33.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $29.51 / $48.98	Facility		$9.77	$29.51	$48.98
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $24.55 / $47.86	Professional		$9.55	$24.55	$47.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $52.48 / $199.53	Facility		$32.36	$52.48	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $45.71 / $66.07	Professional		$29.51	$45.71	$66.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.49 / $20.89	Professional	26	$10.00	$15.49	$20.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $29.51 / $40.74	Professional	TC	$19.95	$29.51	$40.74
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $51.29 / $61.66	Professional		$31.62	$51.29	$61.66
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $16.98 / $20.89	Professional	26	$9.12	$16.98	$20.89
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $28.18 / $42.66	Professional	TC	$19.95	$28.18	$42.66
United Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $165.96 / $309.03	Facility		$128.82	$165.96	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.88 / $58.88	Professional		$28.18	$33.88	$58.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $11.48 / $19.95	Professional	26	$9.12	$11.48	$19.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $22.39 / $39.81	Professional	TC	$18.62	$22.39	$39.81