Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $96.94 / $180.21 / $589.17	Facility		$96.94	$180.21	$589.17
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.70 / $46.57 / $60.21	Facility	26	$45.70	$46.57	$60.21
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $72.84 / $115.17 / $560.91	Facility	TC	$72.84	$115.17	$560.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.18 / $135.11 / $246.00	Professional		$91.18	$135.11	$246.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.41 / $46.57 / $152.91	Professional	26	$31.41	$46.57	$152.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.94 / $67.56 / $80.43	Professional	52	$37.94	$67.56	$80.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.08 / $88.53 / $110.66	Professional	TC	$61.08	$88.53	$110.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.40 / $166.57 / $175.38	Professional		$92.40	$166.57	$175.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.94 / $56.18 / $71.00	Professional	26	$25.94	$56.18	$71.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $105.01 / $111.25 / $152.24	Professional	TC	$105.01	$111.25	$152.24
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 $108.37 / $143.43 / $159.37	Professional		$108.37	$143.43	$159.37
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.92 / $50.19 / $55.77	Professional	26	$37.92	$50.19	$55.77
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.45 / $93.24 / $103.60	Professional	TC	$70.45	$93.24	$103.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $35.54 / $78.04 / $127.76	Facility		$35.54	$78.04	$127.76
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.07 / $71.53 / $133.44	Professional		$34.07	$71.53	$133.44
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 $91.73 / $150.00 / $200.07	Professional		$91.73	$150.00	$200.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.80 / $50.30 / $68.37	Professional	26	$29.80	$50.30	$68.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.54 / $103.12 / $133.06	Professional	TC	$60.54	$103.12	$133.06
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $184.10 / $201.69 / $209.19	Professional		$184.10	$201.69	$209.19
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $43.84 / $65.76 / $81.65	Professional	26	$43.84	$65.76	$81.65
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $120.76 / $127.94 / $175.08	Professional	TC	$120.76	$127.94	$175.08
United Facility/Professional Professional Modifier Low / Median / High Price $103.62 / $131.06 / $197.37	Professional		$103.62	$131.06	$197.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.78 / $42.77 / $67.55	Professional	26	$33.78	$42.77	$67.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.53 / $91.16 / $133.18	Professional	TC	$66.53	$91.16	$133.18