Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.57 / $159.41 / $565.26	Facility		$47.57	$159.41	$565.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.80 / $11.70 / $28.05	Facility	26	$8.80	$11.70	$28.05
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $199.57 / $617.34	Facility	TC	$23.86	$199.57	$617.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.47 / $43.13 / $133.58	Professional		$21.47	$43.13	$133.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $11.61 / $44.75	Professional	26	$7.33	$11.61	$44.75
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $15.10 / $63.78 / $144.00	Professional	50	$15.10	$63.78	$144.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.14 / $17.25 / $21.74	Professional	52	$13.14	$17.25	$21.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.32 / $24.29 / $44.20	Professional	TC	$21.32	$24.29	$44.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.54 / $44.54 / $55.80	Professional		$44.54	$44.54	$55.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.29 / $12.69 / $13.32	Professional	26	$6.29	$12.69	$13.32
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $66.81 / $83.70 / $83.70	Professional	50	$66.81	$83.70	$83.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.33 / $37.35 / $38.86	Professional	TC	$31.33	$37.35	$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 $31.67 / $41.92 / $46.58	Professional		$31.67	$41.92	$46.58
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.22 / $12.20 / $13.56	Professional	26	$9.22	$12.20	$13.56
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.45 / $29.72 / $33.02	Professional	TC	$22.45	$29.72	$33.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.60 / $29.89 / $41.48	Facility		$7.60	$29.89	$41.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.85 / $25.46 / $38.21	Professional		$7.85	$25.46	$38.21
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 $30.51 / $42.91 / $62.27	Professional		$30.51	$42.91	$62.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $11.59 / $19.01	Professional	26	$7.95	$11.59	$19.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.62 / $29.21 / $42.00	Professional	TC	$20.62	$29.21	$42.00
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $51.22 / $57.20 / $64.17	Professional		$51.22	$57.20	$64.17
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $10.11 / $15.17 / $16.95	Professional	26	$10.11	$15.17	$16.95
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $76.83 / $76.83 / $96.26	Professional	50	$76.83	$76.83	$96.26
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $30.98 / $42.95 / $44.69	Professional	TC	$30.98	$42.95	$44.69
United Facility/Professional Professional Modifier Low / Median / High Price $28.92 / $34.97 / $59.76	Professional		$28.92	$34.97	$59.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.70 / $9.82 / $15.86	Professional	26	$7.70	$9.82	$15.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.41 / $24.54 / $44.42	Professional	TC	$20.41	$24.54	$44.42