Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.16 / $174.67 / $540.24	Facility		$79.16	$174.67	$540.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.13 / $11.05 / $13.52	Facility	26	$9.13	$11.05	$13.52
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $187.83 / $438.42	Facility	TC	$26.30	$187.83	$438.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.30 / $42.32 / $94.98	Professional		$24.30	$42.32	$94.98
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 $15.22 / $118.00 / $158.00	Professional	50	$15.22	$118.00	$158.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.64 / $26.97 / $62.40	Professional	TC	$21.64	$26.97	$62.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $38.18 / $46.73 / $62.32	Professional		$38.18	$46.73	$62.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.09 / $13.44 / $19.76	Professional	26	$8.09	$13.44	$19.76
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $70.09 / $91.75 / $91.75	Professional	50	$70.09	$91.75	$91.75
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $32.99 / $32.99 / $41.68	Professional	TC	$32.99	$32.99	$41.68
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 / $33.33 / $45.46	Facility		$7.90	$33.33	$45.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.14 / $28.39 / $41.94	Professional		$8.14	$28.39	$41.94
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 / $43.59 / $62.00	Professional		$30.51	$43.59	$62.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.01 / $12.02 / $16.30	Professional	26	$8.01	$12.02	$16.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.79 / $30.07 / $45.02	Professional	TC	$20.79	$30.07	$45.02
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $53.74 / $63.08 / $71.67	Professional		$53.74	$63.08	$71.67
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $12.91 / $15.80 / $23.70	Professional	26	$12.91	$15.80	$23.70
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $43.91 / $43.91 / $105.51	Professional	50	$43.91	$43.91	$105.51
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $34.11 / $37.94 / $74.80	Professional	TC	$34.11	$37.94	$74.80
United Facility/Professional Professional Modifier Low / Median / High Price $28.99 / $37.20 / $63.67	Professional		$28.99	$37.20	$63.67
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 / $27.01 / $48.95	Professional	TC	$20.41	$27.01	$48.95