Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.96 / $152.69 / $301.02	Professional		$134.96	$152.69	$301.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.94 / $85.09 / $136.00	Professional	26	$58.94	$85.09	$136.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.17 / $86.98 / $120.02	Professional	TC	$77.17	$86.98	$120.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $148.62 / $167.94 / $233.11	Professional		$148.62	$167.94	$233.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $70.36 / $81.56 / $111.06	Professional	26	$70.36	$81.56	$111.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.58 / $97.58 / $97.58	Professional	TC	$97.58	$97.58	$97.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $127.48 / $169.97 / $212.46	Professional		$127.48	$169.97	$212.46
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.47 / $84.62 / $105.78	Professional	26	$63.47	$84.62	$105.78
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.01 / $85.34 / $106.68	Professional	TC	$64.01	$85.34	$106.68
CareSource Facility/Professional Facility Modifier Low / Median / High Price $62.27 / $92.10 / $187.14	Facility		$62.27	$92.10	$187.14
CareSource Facility/Professional Professional Modifier Low / Median / High Price $62.27 / $85.88 / $148.15	Professional		$62.27	$85.88	$148.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.73 / $144.62 / $240.86	Professional		$67.73	$144.62	$240.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.22 / $72.37 / $114.38	Professional	26	$33.22	$72.37	$114.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.64 / $49.62 / $124.89	Professional	TC	$28.64	$49.62	$124.89
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $193.13 / $193.13 / $268.08	Professional		$193.13	$193.13	$268.08
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $80.91 / $93.81 / $127.72	Professional	26	$80.91	$93.81	$127.72
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $112.22 / $112.22 / $112.22	Professional	TC	$112.22	$112.22	$112.22
United Facility/Professional Professional Modifier Low / Median / High Price $77.90 / $118.08 / $157.35	Professional		$77.90	$118.08	$157.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.61 / $66.45 / $97.58	Professional	26	$39.61	$66.45	$97.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.20 / $51.32 / $83.37	Professional	TC	$39.20	$51.32	$83.37