Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $154.88 / $436.52	Facility		$38.90	$154.88	$436.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $10.96 / $13.80	Facility	26	$7.94	$10.96	$13.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $31.62 / $194.98	Facility	TC	$25.70	$31.62	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $36.31 / $107.15	Professional		$12.30	$36.31	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.18 / $39.81	Professional	26	$7.08	$13.18	$39.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $37.15 / $100.00 / $213.80	Professional	50	$37.15	$100.00	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $30.20 / $56.23	Professional	TC	$19.05	$30.20	$56.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $30.20 / $56.23	Professional		$22.91	$30.20	$56.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $9.12 / $14.79	Professional	26	$6.31	$9.12	$14.79
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $70.79 / $97.72	Professional	50	$39.81	$70.79	$97.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $24.55 / $46.77	Professional	TC	$18.62	$24.55	$46.77
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 $33.88 / $38.90 / $50.12	Professional		$33.88	$38.90	$50.12
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $10.96 / $14.13	Professional	26	$9.55	$10.96	$14.13
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 $8.32 / $32.36 / $53.70	Facility		$8.32	$32.36	$53.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.13 / $29.51 / $56.23	Professional		$8.13	$29.51	$56.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $52.48 / $162.18	Facility		$29.51	$52.48	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $43.65 / $69.18	Professional		$30.90	$43.65	$69.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.02 / $18.20	Professional	26	$7.94	$12.02	$18.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $29.51 / $47.86	Professional	TC	$20.42	$29.51	$47.86
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $57.54 / $69.18	Professional		$38.90	$57.54	$69.18
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.49 / $16.98	Professional	26	$10.96	$15.49	$16.98
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $45.71 / $93.33 / $100.00	Professional	50	$45.71	$93.33	$100.00
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $37.15 / $53.70	Professional	TC	$22.39	$37.15	$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 $28.84 / $35.48 / $60.26	Professional		$28.84	$35.48	$60.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.77 / $16.60	Professional	26	$7.94	$9.77	$16.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $26.30 / $44.67	Professional	TC	$20.42	$26.30	$44.67