Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $190.55 / $537.03	Facility		$41.69	$190.55	$537.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $12.30 / $15.14	Facility	26	$10.96	$12.30	$15.14
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $38.90 / $281.84	Facility	TC	$28.84	$38.90	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $40.74 / $123.03	Professional		$10.72	$40.74	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.18 / $38.90	Professional	26	$7.94	$13.18	$38.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.38 / $85.11 / $218.78	Professional	50	$17.38	$85.11	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.11 / $72.44	Professional	TC	$23.44	$33.11	$72.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $33.11 / $61.66	Professional		$26.30	$33.11	$61.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.23 / $16.22	Professional	26	$6.76	$10.23	$16.22
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $57.54 / $104.71	Professional	50	$42.66	$57.54	$104.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $52.48	Professional	TC	$21.88	$31.62	$52.48
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 $38.02 / $43.65 / $54.95	Professional		$38.02	$43.65	$54.95
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $11.75 / $15.14	Professional	26	$10.23	$11.75	$15.14
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $31.62 / $39.81	Professional	TC	$27.54	$31.62	$39.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.12 / $36.31 / $60.26	Facility		$9.12	$36.31	$60.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $33.11 / $63.10	Professional		$8.71	$33.11	$63.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $52.48 / $162.18	Facility		$32.36	$52.48	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $46.77 / $75.86	Professional		$33.11	$46.77	$75.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $12.88 / $18.62	Professional	26	$8.71	$12.88	$18.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.11 / $53.70	Professional	TC	$22.91	$33.11	$53.70
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $66.07 / $79.43	Professional		$44.67	$66.07	$79.43
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $16.60 / $19.50	Professional	26	$11.75	$16.60	$19.50
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $50.12 / $70.79 / $109.65	Professional	50	$50.12	$70.79	$109.65
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $44.67 / $66.07	Professional	TC	$28.84	$44.67	$66.07
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 $31.62 / $39.81 / $67.61	Professional		$31.62	$39.81	$67.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $10.47 / $17.78	Professional	26	$8.71	$10.47	$17.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $30.20 / $51.29	Professional	TC	$22.39	$30.20	$51.29