Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $151.36 / $398.11	Facility		$81.28	$151.36	$398.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $42.66 / $51.29	Facility	26	$41.69	$42.66	$51.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $91.20 / $186.21	Professional		$50.12	$91.20	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $44.67 / $102.33	Professional	26	$26.30	$44.67	$102.33
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $45.71 / $144.54 / $630.96	Professional	50	$45.71	$144.54	$630.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $53.70 / $100.00	Professional	TC	$39.81	$53.70	$100.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $79.43 / $138.04	Professional		$63.10	$79.43	$138.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $33.11 / $54.95	Professional	26	$24.55	$33.11	$54.95
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $173.78 / $194.98 / $213.80	Professional	50	$173.78	$194.98	$213.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $45.71 / $83.18	Professional	TC	$39.81	$45.71	$83.18
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 $85.11 / $97.72 / $123.03	Professional		$85.11	$97.72	$123.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $39.81 / $51.29	Professional	26	$34.67	$39.81	$51.29
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $56.23 / $72.44	Professional	TC	$50.12	$56.23	$72.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $47.86 / $85.11	Facility		$32.36	$47.86	$85.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $52.48 / $104.71	Professional		$31.62	$52.48	$104.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $107.15 / $229.09	Facility		$51.29	$107.15	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $109.65 / $162.18	Professional		$70.79	$109.65	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $42.66 / $66.07	Professional	26	$27.54	$42.66	$66.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $66.07 / $97.72	Professional	TC	$42.66	$66.07	$97.72
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $147.91 / $165.96	Professional		$144.54	$147.91	$165.96
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $58.88 / $63.10	Professional	26	$41.69	$58.88	$63.10
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $199.53 / $223.87 / $245.47	Professional	50	$199.53	$223.87	$245.47
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $89.13 / $95.50	Professional	TC	$89.13	$89.13	$95.50
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 $75.86 / $95.50 / $151.36	Professional		$75.86	$95.50	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $38.02 / $61.66	Professional	26	$30.20	$38.02	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $56.23 / $89.13	Professional	TC	$45.71	$56.23	$89.13