Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $131.83 / $338.84	Facility		$33.88	$131.83	$338.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.47 / $13.49	Facility	26	$10.00	$10.47	$13.49
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.91 / $26.92 / $186.21	Facility	TC	$22.91	$26.92	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $30.90 / $95.50	Professional		$11.75	$30.90	$95.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $11.22 / $34.67	Professional	26	$6.03	$11.22	$34.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $14.13 / $158.49 / $257.04	Professional	50	$14.13	$158.49	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.99 / $46.77	Professional	TC	$15.85	$23.99	$46.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $28.18 / $50.12	Professional		$20.42	$28.18	$50.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $8.13 / $13.80	Professional	26	$5.75	$8.13	$13.80
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $85.11 / $85.11 / $85.11	Professional	50	$85.11	$85.11	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $21.88 / $39.81	Professional	TC	$17.78	$21.88	$39.81
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 $7.76 / $28.18 / $46.77	Facility		$7.76	$28.18	$46.77
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.59 / $25.12 / $48.98	Professional		$7.59	$25.12	$48.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $52.48 / $162.18	Facility		$26.92	$52.48	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $38.90 / $60.26	Professional		$26.92	$38.90	$60.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.02 / $16.60	Professional	26	$7.94	$12.02	$16.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $25.70 / $40.74	Professional	TC	$18.20	$25.70	$40.74
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $47.86 / $57.54	Professional		$32.36	$47.86	$57.54
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.45 / $16.22	Professional	26	$10.47	$14.45	$16.22
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $33.88 / $45.71	Professional	TC	$20.42	$33.88	$45.71
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 $26.30 / $30.90 / $54.95	Professional		$26.30	$30.90	$54.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $8.91 / $15.49	Professional	26	$7.24	$8.91	$15.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $22.91 / $38.90	Professional	TC	$17.78	$22.91	$38.90