Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.63 / $163.80 / $389.92	Facility		$48.63	$163.80	$389.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.74 / $14.18 / $19.14	Facility	26	$11.74	$14.18	$19.14
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.42 / $179.98 / $321.64	Facility	TC	$34.42	$179.98	$321.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.62 / $48.63 / $105.88	Professional		$17.62	$48.63	$105.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.74 / $14.18 / $28.90	Professional	26	$9.74	$14.18	$28.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $34.43 / $79.20	Professional	TC	$27.55	$34.43	$79.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.40 / $64.31 / $78.23	Professional		$40.40	$64.31	$78.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.34 / $16.93 / $19.67	Professional	26	$8.34	$16.93	$19.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.73 / $46.73 / $53.23	Professional	TC	$46.73	$46.73	$53.23
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 $39.61 / $52.43 / $58.25	Professional		$39.61	$52.43	$58.25
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.18 / $14.80 / $16.44	Professional	26	$11.18	$14.80	$16.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.43 / $37.63 / $41.81	Professional	TC	$28.43	$37.63	$41.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.10 / $42.53 / $58.04	Facility		$10.10	$42.53	$58.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.48 / $36.22 / $53.65	Professional		$10.48	$36.22	$53.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $36.95 / $100.68 / $161.54	Facility		$36.95	$100.68	$161.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.59 / $54.36 / $82.40	Professional		$39.59	$54.36	$82.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.25 / $15.37 / $20.96	Professional	26	$10.25	$15.37	$20.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.52 / $39.01 / $60.66	Professional	TC	$28.52	$39.01	$60.66
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $73.97 / $80.68 / $89.98	Professional		$73.97	$80.68	$89.98
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $16.79 / $20.23 / $22.62	Professional	26	$16.79	$20.23	$22.62
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $53.74 / $53.74 / $61.21	Professional	TC	$53.74	$53.74	$61.21
United Facility/Professional Professional Modifier Low / Median / High Price $38.46 / $48.30 / $82.39	Professional		$38.46	$48.30	$82.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.40 / $13.19 / $21.16	Professional	26	$10.40	$13.19	$21.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.49 / $34.61 / $62.07	Professional	TC	$27.49	$34.61	$62.07