Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $31.94 / $91.16 / $308.67	Facility		$31.94	$91.16	$308.67
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.67 / $10.11 / $12.68	Facility	26	$9.67	$10.11	$12.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.82 / $31.30 / $282.63	Facility	TC	$21.82	$31.30	$282.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.82 / $32.86 / $83.70	Professional		$19.82	$32.86	$83.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.74 / $10.11 / $23.80	Professional	26	$6.74	$10.11	$23.80
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $56.00 / $99.92 / $116.00	Professional	50	$56.00	$99.92	$116.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.75 / $21.83 / $41.65	Professional	TC	$18.75	$21.83	$41.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.34 / $42.34 / $43.22	Professional		$42.34	$42.34	$43.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.99 / $12.86 / $14.06	Professional	26	$5.99	$12.86	$14.06
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $56.00 / $56.00 / $56.00	Professional	50	$56.00	$56.00	$56.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $24.65 / $29.13 / $29.13	Professional	TC	$24.65	$29.13	$29.13
BCBS Facility/Professional Facility Modifier Low / Median / High Price $76.62 / $76.62 / $83.36	Facility		$76.62	$76.62	$83.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.33 / $36.17 / $40.19	Professional		$27.33	$36.17	$40.19
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.77 / $11.60 / $12.89	Professional	26	$8.77	$11.60	$12.89
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.55 / $24.57 / $27.30	Professional	TC	$18.55	$24.57	$27.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.57 / $24.53 / $35.86	Facility		$7.57	$24.53	$35.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.80 / $20.90 / $32.96	Professional		$7.80	$20.90	$32.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.54 / $53.76 / $112.48	Facility		$26.54	$53.76	$112.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.99 / $39.33 / $50.74	Professional		$25.99	$39.33	$50.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.23 / $11.02 / $15.60	Professional	26	$7.23	$11.02	$15.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $26.46 / $34.47	Professional	TC	$18.20	$26.46	$34.47
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $48.69 / $48.69 / $49.70	Professional		$48.69	$48.69	$49.70
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $12.08 / $14.79 / $16.85	Professional	26	$12.08	$14.79	$16.85
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $64.40 / $64.40 / $64.40	Professional	50	$64.40	$64.40	$64.40
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $28.35 / $33.50 / $33.50	Professional	TC	$28.35	$33.50	$33.50
United Facility/Professional Facility Modifier Low / Median / High Price $176.10 / $176.10 / $176.10	Facility		$176.10	$176.10	$176.10
United Facility/Professional Professional Modifier Low / Median / High Price $25.20 / $30.44 / $51.97	Professional		$25.20	$30.44	$51.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.40 / $10.37 / $15.75	Professional	26	$7.40	$10.37	$15.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $20.68 / $38.04	Professional	TC	$17.57	$20.68	$38.04