Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $128.82 / $323.59	Facility		$38.90	$128.82	$323.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $12.02 / $14.45	Facility	26	$10.96	$12.02	$14.45
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.92 / $30.20 / $190.55	Facility	TC	$26.92	$30.20	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.02 / $33.11 / $91.20	Professional		$12.02	$33.11	$91.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.96 / $32.36	Professional	26	$7.08	$10.96	$32.36
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.18 / $169.82 / $177.83	Professional	50	$28.18	$169.82	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $25.12 / $58.88	Professional	TC	$17.38	$25.12	$58.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $29.51 / $57.54	Professional		$23.99	$29.51	$57.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $8.91 / $15.85	Professional	26	$6.61	$8.91	$15.85
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	50	$95.50	$95.50	$95.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $29.51 / $48.98	Professional	TC	$23.99	$29.51	$48.98
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 $30.90 / $35.48 / $45.71	Professional		$30.90	$35.48	$45.71
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 $21.88 / $25.12 / $31.62	Professional	TC	$21.88	$25.12	$31.62
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.71 / $31.62 / $52.48	Facility		$8.71	$31.62	$52.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $28.84 / $54.95	Professional		$8.51	$28.84	$54.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $107.15 / $229.09	Facility		$26.30	$107.15	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $42.66 / $67.61	Professional		$30.20	$42.66	$67.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $12.59 / $18.62	Professional	26	$8.32	$12.59	$18.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $29.51 / $50.12	Professional	TC	$21.38	$29.51	$50.12
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $60.26 / $66.07	Professional		$47.86	$60.26	$66.07
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $16.22 / $21.38	Professional	26	$11.48	$16.22	$21.38
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $53.70	Professional	TC	$28.84	$38.90	$53.70
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 $30.20 / $35.48 / $61.66	Professional		$30.20	$35.48	$61.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.47 / $17.38	Professional	26	$8.13	$10.47	$17.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $25.70 / $44.67	Professional	TC	$20.89	$25.70	$44.67