Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $190.55 / $354.81	Facility		$37.15	$190.55	$354.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $11.48 / $13.80	Facility	26	$10.47	$11.48	$13.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $30.90 / $223.87	Facility	TC	$25.70	$30.90	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.79 / $33.11 / $95.50	Professional		$14.79	$33.11	$95.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.48 / $28.18	Professional	26	$7.08	$11.48	$28.18
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $158.49 / $186.21	Professional	50	$42.66	$158.49	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $26.92 / $56.23	Professional	TC	$17.38	$26.92	$56.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $30.90 / $52.48	Professional		$22.39	$30.90	$52.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $9.12 / $15.14	Professional	26	$6.31	$9.12	$15.14
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $32.36 / $39.81 / $95.50	Professional	50	$32.36	$39.81	$95.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $27.54 / $42.66	Professional	TC	$17.38	$27.54	$42.66
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 $9.55 / $10.96 / $14.13	Professional	26	$9.55	$10.96	$14.13
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $23.99 / $30.20	Professional	TC	$20.89	$23.99	$30.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.32 / $29.51 / $48.98	Facility		$8.32	$29.51	$48.98
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.13 / $25.70 / $48.98	Professional		$8.13	$25.70	$48.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $52.48 / $162.18	Facility		$30.20	$52.48	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $44.67 / $61.66	Professional		$28.84	$44.67	$61.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.02 / $18.20	Professional	26	$7.94	$12.02	$18.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $30.90 / $44.67	Professional	TC	$19.95	$30.90	$44.67
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $54.95 / $61.66	Professional		$38.90	$54.95	$61.66
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $15.85 / $22.91	Professional	26	$13.18	$15.85	$22.91
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $45.71 / $45.71 / $45.71	Professional	50	$45.71	$45.71	$45.71
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $35.48 / $46.77	Professional	TC	$26.30	$35.48	$46.77
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 $28.18 / $33.11 / $56.23	Professional		$28.18	$33.11	$56.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.77 / $16.60	Professional	26	$7.94	$9.77	$16.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $22.91 / $40.74	Professional	TC	$19.50	$22.91	$40.74