Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.12 / $151.19 / $383.59	Facility		$47.12	$151.19	$383.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.79 / $11.05 / $13.93	Facility	26	$7.79	$11.05	$13.93
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.89 / $167.28 / $595.05	Facility	TC	$25.89	$167.28	$595.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.36 / $42.18 / $117.00	Professional		$22.36	$42.18	$117.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $11.06 / $42.32	Professional	26	$7.33	$11.06	$42.32
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $72.00 / $72.00 / $72.00	Professional	50	$72.00	$72.00	$72.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.01 / $18.47 / $21.74	Professional	52	$14.01	$18.47	$21.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $26.88 / $48.19	Professional	TC	$21.94	$26.88	$48.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.80 / $48.38 / $53.41	Professional		$30.80	$48.38	$53.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.53 / $13.44 / $14.69	Professional	26	$6.53	$13.44	$14.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $34.09 / $34.09 / $41.87	Professional	TC	$34.09	$34.09	$41.87
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 $33.78 / $44.71 / $49.68	Professional		$33.78	$44.71	$49.68
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.57 / $12.66 / $14.07	Professional	26	$9.57	$12.66	$14.07
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 $7.90 / $32.18 / $44.27	Facility		$7.90	$32.18	$44.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.14 / $27.42 / $40.81	Professional		$8.14	$27.42	$40.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $53.76 / $112.48	Facility		$29.51	$53.76	$112.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.91 / $43.69 / $62.00	Professional		$30.91	$43.69	$62.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.01 / $12.03 / $16.30	Professional	26	$8.01	$12.03	$16.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.58 / $30.06 / $45.02	Professional	TC	$21.58	$30.06	$45.02
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $55.64 / $55.64 / $61.42	Professional		$55.64	$55.64	$61.42
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $13.12 / $15.47 / $17.60	Professional	26	$13.12	$15.47	$17.60
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $39.20 / $39.20 / $48.15	Professional	TC	$39.20	$39.20	$48.15
United Facility/Professional Facility Modifier Low / Median / High Price $176.10 / $176.10 / $176.10	Facility		$176.10	$176.10	$176.10
United Facility/Professional Professional Modifier Low / Median / High Price $28.99 / $35.65 / $63.28	Professional		$28.99	$35.65	$63.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $10.19 / $16.46	Professional	26	$8.11	$10.19	$16.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.41 / $26.35 / $47.80	Professional	TC	$20.41	$26.35	$47.80