Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.78 / $110.86 / $249.46	Professional		$94.78	$110.86	$249.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.37 / $33.85 / $87.28	Professional	26	$22.37	$33.85	$87.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.63 / $78.18 / $161.78	Professional	TC	$71.63	$78.18	$161.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.30 / $107.69 / $150.09	Professional		$95.30	$107.69	$150.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.75 / $31.12 / $42.89	Professional	26	$23.75	$31.12	$42.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $80.84 / $80.84 / $80.84	Professional	TC	$80.84	$80.84	$80.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.92 / $93.04 / $123.14	Professional		$23.92	$93.04	$123.14
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.11 / $31.90 / $39.86	Professional	26	$27.11	$31.90	$39.86
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.93 / $77.56 / $96.95	Professional	TC	$65.93	$77.56	$96.95
CareSource Facility/Professional Facility Modifier Low / Median / High Price $23.78 / $76.11 / $121.02	Facility		$23.78	$76.11	$121.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.78 / $61.95 / $94.83	Professional		$23.78	$61.95	$94.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.68 / $74.73 / $159.35	Professional		$44.68	$74.73	$159.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.65 / $28.11 / $43.44	Professional	26	$12.65	$28.11	$43.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.59 / $48.45 / $113.96	Professional	TC	$27.59	$48.45	$113.96
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $111.79 / $123.84 / $172.60	Professional		$111.79	$123.84	$172.60
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $30.87 / $35.79 / $49.32	Professional	26	$30.87	$35.79	$49.32
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $92.98 / $92.98 / $92.98	Professional	TC	$92.98	$92.98	$92.98
United Facility/Professional Professional Modifier Low / Median / High Price $52.43 / $64.31 / $107.19	Professional		$52.43	$64.31	$107.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.24 / $24.98 / $38.13	Professional	26	$15.24	$24.98	$38.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.36 / $47.94 / $79.40	Professional	TC	$36.36	$47.94	$79.40