Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.82 / $63.15 / $118.88	Professional		$55.82	$63.15	$118.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.24 / $33.27 / $93.57	Professional	26	$23.24	$33.27	$93.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $37.22 / $74.80	Professional	TC	$33.04	$37.22	$74.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.79 / $58.79 / $99.51	Professional		$58.79	$58.79	$99.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.89 / $32.33 / $43.99	Professional	26	$27.89	$32.33	$43.99
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $34.11 / $38.54 / $38.54	Professional	TC	$34.11	$38.54	$38.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.87 / $74.50 / $93.12	Professional		$55.87	$74.50	$93.12
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.14 / $33.52 / $41.90	Professional	26	$25.14	$33.52	$41.90
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.73 / $40.98 / $51.22	Professional	TC	$30.73	$40.98	$51.22
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.70 / $36.28 / $74.00	Facility		$24.70	$36.28	$74.00
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.70 / $33.86 / $58.57	Professional		$24.70	$33.86	$58.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.21 / $72.37 / $132.31	Professional		$34.21	$72.37	$132.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.13 / $34.40 / $65.39	Professional	26	$13.13	$34.40	$65.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.48 / $35.00 / $59.98	Professional	TC	$19.48	$35.00	$59.98
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $76.39 / $76.39 / $114.44	Professional		$76.39	$76.39	$114.44
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $32.07 / $37.18 / $50.59	Professional	26	$32.07	$37.18	$50.59
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $44.32 / $44.32 / $44.32	Professional	TC	$44.32	$44.32	$44.32
United Facility/Professional Professional Modifier Low / Median / High Price $36.47 / $61.71 / $129.62	Professional		$36.47	$61.71	$129.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $28.87 / $73.52	Professional	26	$16.48	$28.87	$73.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $35.72 / $56.10	Professional	TC	$20.39	$35.72	$56.10