Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.90 / $157.97 / $357.00	Professional		$139.90	$157.97	$357.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.61 / $36.95 / $73.98	Professional	26	$31.61	$36.95	$73.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.29 / $122.04 / $241.54	Professional	TC	$108.29	$122.04	$241.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $146.88 / $147.09 / $147.09	Professional		$146.88	$147.09	$147.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.27 / $34.53 / $50.31	Professional	26	$17.27	$34.53	$50.31
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.55 / $112.55 / $112.55	Professional	TC	$112.55	$112.55	$112.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.69 / $158.44 / $209.70	Professional		$34.69	$158.44	$209.70
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.31 / $46.25 / $57.81	Professional	26	$39.31	$46.25	$57.81
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $119.13 / $140.15 / $175.19	Professional	TC	$119.13	$140.15	$175.19
CareSource Facility/Professional Facility Modifier Low / Median / High Price $34.53 / $119.38 / $187.02	Facility		$34.53	$119.38	$187.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.53 / $95.60 / $146.11	Professional		$34.53	$95.60	$146.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.82 / $113.15 / $223.79	Professional		$54.82	$113.15	$223.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.21 / $39.35 / $66.86	Professional	26	$18.21	$39.35	$66.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.19 / $77.34 / $197.07	Professional	TC	$35.19	$77.34	$197.07
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $120.75 / $168.91 / $191.14	Professional		$120.75	$168.91	$191.14
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $52.03 / $52.03 / $57.86	Professional	26	$52.03	$52.03	$57.86
United Facility/Professional Professional Modifier Low / Median / High Price $63.19 / $103.76 / $175.40	Professional		$63.19	$103.76	$175.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.19 / $32.04 / $52.08	Professional	26	$22.19	$32.04	$52.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.11 / $70.01 / $135.34	Professional	TC	$40.11	$70.01	$135.34