Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $169.82 / $346.74	Facility		$43.65	$169.82	$346.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $14.13 / $17.78	Facility	26	$14.13	$14.13	$17.78
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $30.20 / $45.71	Facility	TC	$28.84	$30.20	$45.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $43.65 / $114.82	Professional		$30.20	$43.65	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.96 / $28.84	Professional	26	$7.94	$10.96	$28.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	50	$120.23	$120.23	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $28.84 / $56.23	Professional	TC	$20.89	$28.84	$56.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $36.31 / $69.18	Professional		$26.30	$36.31	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.02 / $19.05	Professional	26	$7.94	$12.02	$19.05
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $15.14 / $15.14 / $15.14	Professional	52	$15.14	$15.14	$15.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $37.15 / $53.70	Professional	TC	$22.39	$37.15	$53.70
BCBS Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $147.91	Facility		$107.15	$107.15	$147.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $40.74 / $52.48	Professional		$35.48	$40.74	$52.48
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $12.88 / $16.60	Professional	26	$11.22	$12.88	$16.60
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $27.54 / $35.48	Professional	TC	$23.99	$27.54	$35.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.72 / $37.15 / $61.66	Facility		$10.72	$37.15	$61.66
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $32.36 / $61.66	Professional		$10.47	$32.36	$61.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $131.83 / $281.84	Facility		$29.51	$131.83	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $50.12 / $79.43	Professional		$35.48	$50.12	$79.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $15.49 / $22.91	Professional	26	$10.23	$15.49	$22.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.88 / $56.23	Professional	TC	$25.12	$33.88	$56.23
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $70.79 / $79.43	Professional		$46.77	$70.79	$79.43
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $20.42 / $22.39	Professional	26	$13.80	$20.42	$22.39
Qualchoice Facility/Professional Professional Modifier 52 Low / Median / High Price $17.38 / $17.38 / $17.38	Professional	52	$17.38	$17.38	$17.38
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $44.67 / $57.54	Professional	TC	$33.11	$44.67	$57.54
United Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $165.96 / $309.03	Facility		$128.82	$165.96	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $41.69 / $72.44	Professional		$35.48	$41.69	$72.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $12.88 / $21.38	Professional	26	$10.00	$12.88	$21.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $28.84 / $50.12	Professional	TC	$25.12	$28.84	$50.12