Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.75 / $144.44 / $208.00	Facility		$87.75	$144.44	$208.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.78 / $64.73 / $82.80	Facility	26	$47.78	$64.73	$82.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.32 / $89.50 / $173.63	Professional		$40.32	$89.50	$173.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.81 / $48.42 / $102.00	Professional	26	$25.81	$48.42	$102.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $179.00 / $179.00 / $179.00	Professional	50	$179.00	$179.00	$179.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.45 / $36.88 / $48.31	Professional	TC	$12.45	$36.88	$48.31
BCBS Facility/Professional Facility Modifier Low / Median / High Price $107.60 / $107.60 / $117.07	Facility		$107.60	$107.60	$117.07
BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.87 / $76.59 / $85.11	Professional		$57.87	$76.59	$85.11
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.27 / $45.35 / $50.39	Professional	26	$34.27	$45.35	$50.39
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.61 / $31.25 / $34.72	Professional	TC	$23.61	$31.25	$34.72
CareSource Facility/Professional Facility Modifier Low / Median / High Price $17.23 / $33.72 / $57.81	Facility		$17.23	$33.72	$57.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.67 / $31.94 / $60.38	Professional		$15.67	$31.94	$60.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.33 / $115.03 / $175.57	Facility		$66.33	$115.03	$175.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.44 / $97.59 / $145.00	Professional		$42.44	$97.59	$145.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.77 / $56.93 / $78.00	Professional	26	$26.77	$56.93	$78.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.20 / $37.72 / $76.97	Professional	TC	$15.20	$37.72	$76.97
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $83.63 / $83.63 / $83.63	Professional		$83.63	$83.63	$83.63
United Facility/Professional Professional Modifier Low / Median / High Price $48.80 / $87.91 / $148.66	Professional		$48.80	$87.91	$148.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.32 / $50.25 / $65.95	Professional	26	$30.32	$50.25	$65.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.29 / $28.46 / $60.75	Professional	TC	$19.29	$28.46	$60.75