Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $125.89 / $616.60	Facility		$125.89	$125.89	$616.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $44.67 / $44.67	Facility	26	$44.67	$44.67	$44.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	TC	$81.28	$81.28	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $107.15 / $323.59	Professional		$75.86	$107.15	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $42.66 / $117.49	Professional	26	$25.70	$42.66	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $64.57 / $177.83	Professional	TC	$48.98	$64.57	$177.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $97.72 / $114.82	Professional		$51.29	$97.72	$114.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $22.91 / $40.74	Professional	26	$15.85	$22.91	$40.74
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $41.69 / $75.86	Professional	TC	$41.69	$41.69	$75.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $100.00 / $131.83	Professional		$87.10	$100.00	$131.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $47.86	Professional	26	$36.31	$36.31	$47.86
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $63.10 / $83.18	Professional	TC	$63.10	$63.10	$83.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $67.61 / $112.20	Facility		$32.36	$67.61	$112.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $64.57 / $95.50	Professional		$30.90	$64.57	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $97.72 / $154.88	Professional		$48.98	$97.72	$154.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $43.65 / $67.61	Professional	26	$19.95	$43.65	$67.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $46.77 / $100.00	Professional	TC	$23.44	$46.77	$100.00
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $112.20 / $158.49	Professional		$95.50	$112.20	$158.49
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $41.69 / $64.57	Professional	26	$40.74	$41.69	$64.57
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $87.10 / $87.10	Professional	TC	$87.10	$87.10	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $87.10 / $128.82	Professional		$48.98	$87.10	$128.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $33.11 / $60.26	Professional	26	$20.89	$33.11	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $44.67 / $70.79	Professional	TC	$28.18	$44.67	$70.79