Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.10 / $185.98 / $688.86	Facility		$97.10	$185.98	$688.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.40 / $35.47 / $43.36	Facility	26	$33.40	$35.47	$43.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.84 / $130.51 / $195.71	Professional		$93.84	$130.51	$195.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.28 / $35.47 / $70.55	Professional	26	$23.28	$35.47	$70.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $39.31 / $65.63 / $73.19	Professional	52	$39.31	$65.63	$73.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.96 / $95.45 / $115.53	Professional	TC	$63.96	$95.45	$115.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.22 / $162.00 / $183.24	Professional		$120.22	$162.00	$183.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.04 / $42.31 / $48.08	Professional	26	$20.04	$42.31	$48.08
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $40.32 / $40.32 / $40.32	Professional	52	$40.32	$40.32	$40.32
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $118.97 / $125.16 / $136.88	Professional	TC	$118.97	$125.16	$136.88
BCBS Facility/Professional Facility Modifier Low / Median / High Price $107.60 / $107.60 / $117.07	Facility		$107.60	$107.60	$117.07
BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.92 / $145.49 / $161.65	Professional		$109.92	$145.49	$161.65
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.88 / $38.22 / $42.47	Professional	26	$28.88	$38.22	$42.47
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.04 / $107.26 / $119.18	Professional	TC	$81.04	$107.26	$119.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.34 / $88.42 / $128.69	Facility		$27.34	$88.42	$128.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $80.94 / $134.41	Professional		$26.17	$80.94	$134.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.31 / $123.30 / $179.19	Facility		$88.31	$123.30	$179.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.17 / $137.53 / $202.98	Professional		$90.17	$137.53	$202.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.63 / $38.31 / $52.71	Professional	26	$22.63	$38.31	$52.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.43 / $102.70 / $150.85	Professional	TC	$64.43	$102.70	$150.85
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $169.43 / $186.30 / $207.38	Professional		$169.43	$186.30	$207.38
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $33.29 / $49.63 / $56.53	Professional	26	$33.29	$49.63	$56.53
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $132.28 / $142.36 / $157.41	Professional	TC	$132.28	$142.36	$157.41
United Facility/Professional Facility Modifier Low / Median / High Price $143.63 / $212.68 / $212.68	Facility		$143.63	$212.68	$212.68
United Facility/Professional Professional Modifier Low / Median / High Price $98.54 / $119.29 / $192.51	Professional		$98.54	$119.29	$192.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.88 / $32.11 / $51.46	Professional	26	$25.88	$32.11	$51.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.62 / $90.09 / $144.19	Professional	TC	$72.62	$90.09	$144.19