Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $151.36 / $389.05	Facility		$42.66	$151.36	$389.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $12.30 / $15.14	Facility	26	$10.23	$12.30	$15.14
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.39 / $117.49 / $363.08	Facility	TC	$22.39	$117.49	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $34.67 / $91.20	Professional		$9.12	$34.67	$91.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $11.75 / $32.36	Professional	26	$7.41	$11.75	$32.36
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.51 / $70.79 / $158.49	Professional	50	$29.51	$70.79	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.18 / $64.57	Professional	TC	$19.05	$28.18	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $28.18 / $53.70	Professional		$21.38	$28.18	$53.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $9.55 / $15.85	Professional	26	$6.76	$9.55	$15.85
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $31.62 / $46.77 / $93.33	Professional	50	$31.62	$46.77	$93.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $23.99 / $40.74	Professional	TC	$16.60	$23.99	$40.74
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 $30.90 / $35.48 / $44.67	Professional		$30.90	$35.48	$44.67
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $11.75 / $15.14	Professional	26	$10.23	$11.75	$15.14
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $23.44 / $30.20	Professional	TC	$20.42	$23.44	$30.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.12 / $30.90 / $51.29	Facility		$9.12	$30.90	$51.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $26.92 / $51.29	Professional		$8.71	$26.92	$51.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $52.48 / $162.18	Facility		$29.51	$52.48	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $43.65 / $64.57	Professional		$29.51	$43.65	$64.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $12.88 / $19.50	Professional	26	$8.71	$12.88	$19.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.18 / $44.67	Professional	TC	$20.42	$28.18	$44.67
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $56.23 / $67.61	Professional		$35.48	$56.23	$67.61
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $16.22 / $19.05	Professional	26	$10.23	$16.22	$19.05
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $70.79 / $93.33	Professional	50	$41.69	$70.79	$93.33
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $29.51 / $48.98	Professional	TC	$21.88	$29.51	$48.98
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 / $60.26	Professional		$28.84	$33.88	$60.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $10.47 / $17.78	Professional	26	$8.51	$10.47	$17.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $23.99 / $42.66	Professional	TC	$19.50	$23.99	$42.66