Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $131.83 / $323.59	Facility		$33.88	$131.83	$323.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.47 / $12.88	Facility	26	$10.00	$10.47	$12.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $24.55 / $181.97	Facility	TC	$19.95	$24.55	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $28.18 / $83.18	Professional		$10.72	$28.18	$83.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $10.47 / $33.11	Professional	26	$6.03	$10.47	$33.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $141.25 / $141.25 / $144.54	Professional	50	$141.25	$141.25	$144.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $20.89 / $43.65	Professional	TC	$14.13	$20.89	$43.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $22.91 / $45.71	Professional		$18.20	$22.91	$45.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $7.59 / $13.49	Professional	26	$5.75	$7.59	$13.49
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $79.43 / $79.43 / $85.11	Professional	50	$79.43	$79.43	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $18.20 / $36.31	Professional	TC	$14.79	$18.20	$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 $28.18 / $32.36 / $41.69	Professional		$28.18	$32.36	$41.69
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $10.47 / $13.49	Professional	26	$9.12	$10.47	$13.49
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $21.88 / $28.18	Professional	TC	$19.50	$21.88	$28.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.76 / $26.30 / $43.65	Facility		$7.76	$26.30	$43.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.59 / $22.91 / $43.65	Professional		$7.59	$22.91	$43.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $52.48 / $162.18	Facility		$26.92	$52.48	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $38.90 / $54.95	Professional		$25.12	$38.90	$54.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $11.48 / $16.60	Professional	26	$7.41	$11.48	$16.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $26.30 / $37.15	Professional	TC	$17.78	$26.30	$37.15
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $44.67 / $54.95	Professional		$37.15	$44.67	$54.95
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.13 / $16.22	Professional	26	$10.00	$14.13	$16.22
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $20.89 / $42.66	Professional	TC	$17.38	$20.89	$42.66
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 $25.70 / $29.51 / $51.29	Professional		$25.70	$29.51	$51.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $9.12 / $15.49	Professional	26	$7.59	$9.12	$15.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $20.42 / $36.31	Professional	TC	$17.78	$20.42	$36.31