Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $36.88 / $81.59 / $273.23	Facility		$36.88	$81.59	$273.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.92 / $10.99 / $13.49	Facility	26	$10.92	$10.99	$13.49
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.89 / $27.97 / $263.64	Facility	TC	$25.89	$27.97	$263.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.14 / $36.88 / $64.31	Professional		$21.14	$36.88	$64.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.61 / $10.99 / $30.79	Professional	26	$7.61	$10.99	$30.79
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $120.00 / $120.00 / $120.00	Professional	50	$120.00	$120.00	$120.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.43 / $18.44 / $82.74	Professional	52	$11.43	$18.44	$82.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $25.89 / $44.36	Professional	TC	$20.07	$25.89	$44.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.09 / $45.09 / $46.00	Professional		$45.09	$45.09	$46.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.61 / $13.74 / $19.68	Professional	26	$12.61	$13.74	$19.68
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.33 / $31.33 / $31.33	Professional	TC	$31.33	$31.33	$31.33
BCBS Facility/Professional Facility Modifier Low / Median / High Price $76.62 / $76.62 / $83.36	Facility		$76.62	$76.62	$83.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.33 / $42.79 / $47.54	Professional		$32.33	$42.79	$47.54
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.17 / $12.13 / $13.48	Professional	26	$9.17	$12.13	$13.48
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.16 / $30.65 / $34.06	Professional	TC	$23.16	$30.65	$34.06
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.57 / $29.50 / $41.03	Facility		$7.57	$29.50	$41.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.80 / $25.13 / $37.79	Professional		$7.80	$25.13	$37.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.98 / $53.76 / $112.48	Facility		$26.98	$53.76	$112.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.13 / $40.79 / $58.18	Professional		$28.13	$40.79	$58.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.61 / $11.93 / $15.60	Professional	26	$7.61	$11.93	$15.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.93 / $28.37 / $41.92	Professional	TC	$19.93	$28.37	$41.92
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $51.85 / $51.85 / $51.85	Professional		$51.85	$51.85	$51.85
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $13.12 / $15.80 / $21.76	Professional	26	$13.12	$15.80	$21.76
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $36.03 / $36.03 / $36.03	Professional	TC	$36.03	$36.03	$36.03
United Facility/Professional Professional Modifier Low / Median / High Price $26.56 / $33.36 / $58.68	Professional		$26.56	$33.36	$58.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.81 / $9.01 / $15.75	Professional	26	$7.81	$9.01	$15.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.89 / $26.99 / $42.37	Professional	TC	$18.89	$26.99	$42.37