Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.04 / $63.58 / $92.00	Professional		$48.04	$63.58	$92.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.77 / $28.10 / $45.60	Professional	26	$20.77	$28.10	$45.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.11 / $31.79 / $47.57	Professional	52	$21.11	$31.79	$47.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.36 / $35.47 / $52.62	Professional	TC	$24.36	$35.47	$52.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $73.73 / $73.73	Professional		$73.73	$73.73	$73.73
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $41.16 / $41.16 / $41.16	Professional	TC	$41.16	$41.16	$41.16
BCBS Facility/Professional Facility Modifier Low / Median / High Price $110.22 / $110.22 / $110.22	Facility		$110.22	$110.22	$110.22
BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.15 / $82.26 / $91.40	Professional		$62.15	$82.26	$91.40
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.49 / $37.71 / $41.90	Professional	26	$28.49	$37.71	$41.90
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.65 / $44.55 / $49.50	Professional	TC	$33.65	$44.55	$49.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.68 / $32.65 / $57.35	Facility		$24.68	$32.65	$57.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.41 / $31.22 / $57.35	Professional		$24.41	$31.22	$57.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.44 / $86.74 / $105.88	Professional		$49.44	$86.74	$105.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.99 / $33.25 / $51.27	Professional	26	$21.99	$33.25	$51.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.04 / $43.22 / $70.48	Professional	TC	$28.04	$43.22	$70.48
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $84.80 / $84.80 / $84.80	Professional		$84.80	$84.80	$84.80
United Facility/Professional Professional Modifier Low / Median / High Price $46.90 / $62.31 / $112.60	Professional		$46.90	$62.31	$112.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.16 / $26.60 / $41.77	Professional	26	$19.16	$26.60	$41.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.92 / $34.29 / $60.49	Professional	TC	$25.92	$34.29	$60.49