Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.68 / $124.80 / $368.96	Facility		$43.68	$124.80	$368.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.33 / $11.36 / $14.28	Facility	26	$10.33	$11.36	$14.28
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.48 / $34.95 / $565.26	Facility	TC	$25.48	$34.95	$565.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.45 / $36.83 / $97.00	Professional		$16.45	$36.83	$97.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.29 / $10.58 / $38.82	Professional	26	$7.29	$10.58	$38.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.80 / $56.00 / $252.00	Professional	50	$30.80	$56.00	$252.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.99 / $18.23 / $20.42	Professional	52	$12.99	$18.23	$20.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $25.89 / $48.73	Professional	TC	$19.46	$25.89	$48.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.84 / $45.09 / $49.96	Professional		$36.84	$45.09	$49.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.56 / $13.12 / $14.99	Professional	26	$6.56	$13.12	$14.99
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $53.00 / $83.57 / $83.57	Professional	50	$53.00	$83.57	$83.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.23 / $30.23 / $38.86	Professional	TC	$30.23	$30.23	$38.86
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 $33.65 / $44.55 / $49.50	Professional		$33.65	$44.55	$49.50
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $12.50 / $13.89	Professional	26	$9.44	$12.50	$13.89
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.21 / $32.04 / $35.61	Professional	TC	$24.21	$32.04	$35.61
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.57 / $29.89 / $41.44	Facility		$7.57	$29.89	$41.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.80 / $25.46 / $38.18	Professional		$7.80	$25.46	$38.18
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 $29.71 / $42.38 / $59.42	Professional		$29.71	$42.38	$59.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $12.61 / $16.26	Professional	26	$7.95	$12.61	$16.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.23 / $28.67 / $42.57	Professional	TC	$20.23	$28.67	$42.57
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $42.37 / $57.45 / $58.03	Professional		$42.37	$57.45	$58.03
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $15.09 / $17.07	Professional	26	$12.59	$15.09	$17.07
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $60.95 / $96.11 / $96.11	Professional	50	$60.95	$96.11	$96.11
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $34.76 / $34.76 / $44.69	Professional	TC	$34.76	$34.76	$44.69
United Facility/Professional Professional Modifier Low / Median / High Price $27.23 / $34.94 / $59.50	Professional		$27.23	$34.94	$59.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.98 / $10.39 / $15.75	Professional	26	$7.98	$10.39	$15.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.57 / $25.48 / $44.42	Professional	TC	$19.57	$25.48	$44.42