Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.19 / $170.02 / $566.91	Facility		$44.19	$170.02	$566.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.97 / $11.70 / $15.69	Facility	26	$10.97	$11.70	$15.69
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.96 / $47.73 / $459.28	Facility	TC	$29.96	$47.73	$459.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.36 / $48.70 / $126.22	Professional		$22.36	$48.70	$126.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.63 / $12.84 / $48.60	Professional	26	$7.63	$12.84	$48.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $44.56 / $122.00 / $178.00	Professional	50	$44.56	$122.00	$178.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.37 / $31.62 / $71.20	Professional	TC	$25.37	$31.62	$71.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.34 / $54.42 / $67.59	Professional		$48.34	$54.42	$67.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.52 / $13.44 / $15.30	Professional	26	$6.52	$13.44	$15.30
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $101.41 / $101.41 / $101.41	Professional	50	$101.41	$101.41	$101.41
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $40.13 / $40.13 / $47.45	Professional	TC	$40.13	$40.13	$47.45
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 $36.96 / $48.92 / $54.35	Professional		$36.96	$48.92	$54.35
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.57 / $12.66 / $14.07	Professional	26	$9.57	$12.66	$14.07
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.39 / $36.25 / $40.28	Professional	TC	$27.39	$36.25	$40.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.90 / $37.11 / $50.23	Facility		$7.90	$37.11	$50.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.14 / $32.32 / $46.41	Professional		$8.14	$32.32	$46.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.95 / $53.76 / $112.48	Facility		$32.95	$53.76	$112.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.11 / $45.00 / $68.81	Professional		$32.11	$45.00	$68.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.01 / $12.03 / $16.30	Professional	26	$8.01	$12.03	$16.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.61 / $33.07 / $51.84	Professional	TC	$22.61	$33.07	$51.84
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $62.58 / $69.70 / $77.73	Professional		$62.58	$69.70	$77.73
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.76 / $17.60	Professional	26	$10.96	$15.76	$17.60
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $116.62 / $116.62 / $116.62	Professional	50	$116.62	$116.62	$116.62
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $46.15 / $46.15 / $69.23	Professional	TC	$46.15	$46.15	$69.23
United Facility/Professional Professional Modifier Low / Median / High Price $30.73 / $39.57 / $70.81	Professional		$30.73	$39.57	$70.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.06 / $10.19 / $16.80	Professional	26	$8.06	$10.19	$16.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.15 / $30.59 / $54.57	Professional	TC	$22.15	$30.59	$54.57