Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $138.04 / $645.65	Professional		$81.28	$138.04	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $47.86 / $151.36	Professional	26	$28.18	$47.86	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $64.57 / $104.71	Professional	TC	$53.70	$64.57	$104.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $120.23 / $208.93	Professional		$70.79	$120.23	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.92 / $48.98	Professional	26	$19.05	$26.92	$48.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $74.13 / $74.13	Professional	TC	$74.13	$74.13	$74.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $120.23 / $158.49	Professional		$104.71	$120.23	$158.49
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $43.65 / $57.54	Professional	26	$43.65	$43.65	$57.54
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $75.86 / $100.00	Professional	TC	$75.86	$75.86	$100.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $67.61 / $120.23	Facility		$38.02	$67.61	$120.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $67.61 / $102.33	Professional		$37.15	$67.61	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $112.20 / $194.98	Professional		$54.95	$112.20	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $52.48 / $77.62	Professional	26	$19.50	$52.48	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $66.07 / $120.23	Professional	TC	$26.92	$66.07	$120.23
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $138.04 / $239.88	Professional		$134.90	$138.04	$239.88
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $47.86 / $56.23	Professional	26	$47.86	$47.86	$56.23
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $85.11 / $85.11	Professional	TC	$85.11	$85.11	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $104.71 / $151.36	Professional		$67.61	$104.71	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $39.81 / $77.62	Professional	26	$25.12	$39.81	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $50.12 / $91.20	Professional	TC	$41.69	$50.12	$91.20