Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $282.62 / $789.43 / $1,919.56	Facility		$282.62	$789.43	$1,919.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.72 / $92.16 / $625.50	Facility	26	$64.72	$92.16	$625.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.28 / $247.69 / $703.80	Professional		$180.28	$247.69	$703.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.36 / $80.98 / $177.60	Professional	26	$62.36	$80.98	$177.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.62 / $155.53 / $259.56	Professional	TC	$129.62	$155.53	$259.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $226.07 / $256.20 / $351.85	Professional		$226.07	$256.20	$351.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $68.00 / $97.91 / $140.31	Professional	26	$68.00	$97.91	$140.31
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $141.88 / $236.47 / $253.44	Professional	TC	$141.88	$236.47	$253.44
BCBS Facility/Professional Facility Modifier Low / Median / High Price $477.58 / $477.58 / $477.58	Facility		$477.58	$477.58	$477.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $212.85 / $281.70 / $281.70	Professional		$212.85	$281.70	$281.70
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.51 / $106.55 / $106.55	Professional	26	$80.51	$106.55	$106.55
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $132.33 / $175.15 / $175.15	Professional	TC	$132.33	$175.15	$175.15
CareSource Facility/Professional Facility Modifier Low / Median / High Price $69.70 / $135.13 / $230.46	Facility		$69.70	$135.13	$230.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $66.73 / $123.87 / $240.70	Professional		$66.73	$123.87	$240.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $486.31 / $514.41 / $675.12	Facility		$486.31	$514.41	$675.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $211.56 / $304.37 / $421.14	Professional		$211.56	$304.37	$421.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.92 / $102.66 / $157.69	Professional	26	$71.92	$102.66	$157.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.51 / $205.53 / $273.57	Professional	TC	$135.51	$205.53	$273.57
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $241.50 / $259.98 / $311.81	Professional		$241.50	$259.98	$311.81
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $96.82 / $109.19 / $161.36	Professional	26	$96.82	$109.19	$161.36
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $163.16 / $193.38 / $291.45	Professional	TC	$163.16	$193.38	$291.45
United Facility/Professional Professional Modifier Low / Median / High Price $179.77 / $274.94 / $440.74	Professional		$179.77	$274.94	$440.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.36 / $94.23 / $147.44	Professional	26	$64.36	$94.23	$147.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.96 / $177.35 / $289.79	Professional	TC	$115.96	$177.35	$289.79