Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.38 / $334.20 / $937.55	Facility		$97.38	$334.20	$937.55
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.92 / $51.06 / $62.53	Facility	26	$41.92	$51.06	$62.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.72 / $146.09 / $357.30	Professional		$98.72	$146.09	$357.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.04 / $51.06 / $171.24	Professional	26	$33.04	$51.06	$171.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.68 / $95.04 / $115.78	Professional	TC	$65.68	$95.04	$115.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $99.07 / $173.42 / $195.09	Professional		$99.07	$173.42	$195.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.41 / $60.44 / $68.67	Professional	26	$28.41	$60.44	$68.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $111.27 / $115.78 / $127.56	Professional	TC	$111.27	$115.78	$127.56
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 $116.98 / $154.83 / $172.03	Professional		$116.98	$154.83	$172.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.58 / $55.04 / $61.15	Professional	26	$41.58	$55.04	$61.15
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.40 / $99.79 / $110.88	Professional	TC	$75.40	$99.79	$110.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $39.03 / $82.69 / $136.96	Facility		$39.03	$82.69	$136.96
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.39 / $75.80 / $143.04	Professional		$37.39	$75.80	$143.04
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 $98.33 / $171.99 / $215.01	Professional		$98.33	$171.99	$215.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.43 / $55.14 / $74.95	Professional	26	$32.43	$55.14	$74.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.14 / $109.59 / $140.19	Professional	TC	$64.14	$109.59	$140.19
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $197.47 / $199.43 / $220.20	Professional		$197.47	$199.43	$220.20
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $48.47 / $72.70 / $90.85	Professional	26	$48.47	$72.70	$90.85
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $127.96 / $134.62 / $187.93	Professional	TC	$127.96	$134.62	$187.93
United Facility/Professional Professional Modifier Low / Median / High Price $110.96 / $138.35 / $217.11	Professional		$110.96	$138.35	$217.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.50 / $45.39 / $74.45	Professional	26	$37.50	$45.39	$74.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.53 / $92.70 / $134.85	Professional	TC	$72.53	$92.70	$134.85