Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.29 / $190.68 / $565.26	Facility		$47.29	$190.68	$565.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.80 / $12.18 / $15.14	Facility	26	$8.80	$12.18	$15.14
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.96 / $193.75 / $586.60	Facility	TC	$29.96	$193.75	$586.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.39 / $47.29 / $117.90	Professional		$25.39	$47.29	$117.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $12.56 / $51.85	Professional	26	$8.56	$12.56	$51.85
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.35 / $56.00 / $172.00	Professional	50	$16.35	$56.00	$172.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.53 / $20.94 / $23.64	Professional	52	$15.53	$20.94	$23.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $29.96 / $54.79	Professional	TC	$24.44	$29.96	$54.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.19 / $59.74 / $67.88	Professional		$35.19	$59.74	$67.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.74 / $14.50 / $16.51	Professional	26	$7.74	$14.50	$16.51
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $48.02 / $79.18 / $99.93	Professional	50	$48.02	$79.18	$99.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.78 / $37.38 / $47.38	Professional	TC	$33.78	$37.38	$47.38
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 $37.71 / $49.91 / $55.46	Professional		$37.71	$49.91	$55.46
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.34 / $13.68 / $15.20	Professional	26	$10.34	$13.68	$15.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.38 / $36.22 / $40.26	Professional	TC	$27.38	$36.22	$40.26
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.51 / $36.40 / $49.49	Facility		$8.51	$36.40	$49.49
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.80 / $31.00 / $45.70	Professional		$8.80	$31.00	$45.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.59 / $53.76 / $112.48	Facility		$32.59	$53.76	$112.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.44 / $47.40 / $72.00	Professional		$33.44	$47.40	$72.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.63 / $13.39 / $17.59	Professional	26	$8.63	$13.39	$17.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.96 / $33.47 / $53.24	Professional	TC	$23.96	$33.47	$53.24
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $60.71 / $68.70 / $78.06	Professional		$60.71	$68.70	$78.06
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $14.17 / $17.02 / $18.98	Professional	26	$14.17	$17.02	$18.98
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $91.06 / $91.06 / $91.06	Professional	50	$91.06	$91.06	$91.06
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $38.85 / $42.99 / $64.48	Professional	TC	$38.85	$42.99	$64.48
United Facility/Professional Professional Modifier Low / Median / High Price $31.53 / $39.99 / $70.73	Professional		$31.53	$39.99	$70.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.47 / $10.54 / $17.76	Professional	26	$8.47	$10.54	$17.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.53 / $32.31 / $54.04	Professional	TC	$22.53	$32.31	$54.04