Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $269.15 / $426.58	Facility		$89.13	$269.15	$426.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $104.71 / $114.82	Facility	26	$51.29	$104.71	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $83.18 / $234.42	Professional		$60.26	$83.18	$234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $120.23	Professional	26	$33.11	$45.71	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $32.36 / $147.91	Professional	TC	$25.12	$32.36	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $30.20 / $66.07	Professional		$26.92	$30.20	$66.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $41.69 / $81.28	Professional	26	$29.51	$41.69	$81.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $15.14 / $25.12	Professional	TC	$12.02	$15.14	$25.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $147.91 / $204.17	Facility		$147.91	$147.91	$204.17
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $85.11	Professional		$64.57	$64.57	$85.11
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $37.15 / $48.98	Professional	26	$37.15	$37.15	$48.98
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $26.92 / $36.31	Professional	TC	$26.92	$26.92	$36.31
CareSource Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $58.88 / $138.04	Facility		$35.48	$58.88	$138.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $47.86 / $95.50	Professional		$29.51	$47.86	$95.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Facility		$109.65	$109.65	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $144.54 / $295.12	Professional		$89.13	$144.54	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $131.83	Professional	26	$52.48	$81.28	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $61.66 / $186.21	Professional	TC	$36.31	$61.66	$186.21
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $52.48 / $114.82	Professional		$51.29	$52.48	$114.82
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	26	$93.33	$93.33	$93.33
United Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $331.13 / $776.25	Facility		$128.82	$331.13	$776.25
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $112.20 / $281.84	Professional		$60.26	$112.20	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $58.88 / $112.20	Professional	26	$34.67	$58.88	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $44.67 / $162.18	Professional	TC	$25.12	$44.67	$162.18