Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $211.80 / $299.10 / $611.04	Facility		$211.80	$299.10	$611.04
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.24 / $50.22 / $52.69	Facility	26	$39.24	$50.22	$52.69
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $186.18 / $258.95 / $471.57	Facility	TC	$186.18	$258.95	$471.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.31 / $267.87 / $452.20	Professional		$189.31	$267.87	$452.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $43.16 / $79.05	Professional	26	$28.51	$43.16	$79.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $161.62 / $212.85 / $387.82	Professional	TC	$161.62	$212.85	$387.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.68 / $269.27 / $405.19	Professional		$198.68	$269.27	$405.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $51.35 / $61.58	Professional	26	$33.97	$51.35	$61.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $223.98 / $223.98 / $223.98	Professional	TC	$223.98	$223.98	$223.98
BCBS Facility/Professional Facility Modifier Low / Median / High Price $221.67 / $221.67 / $221.67	Facility		$221.67	$221.67	$221.67
BCBS Facility/Professional Professional Modifier Low / Median / High Price $258.58 / $342.23 / $342.23	Professional		$258.58	$342.23	$342.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.79 / $56.64 / $56.64	Professional	26	$42.79	$56.64	$56.64
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $215.78 / $285.60 / $285.60	Professional	TC	$215.78	$285.60	$285.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $37.38 / $211.33 / $275.58	Facility		$37.38	$211.33	$275.58
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.90 / $195.14 / $287.83	Professional		$35.90	$195.14	$287.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $172.25 / $232.15 / $434.20	Facility		$172.25	$232.15	$434.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $232.79 / $346.53 / $432.31	Professional		$232.79	$346.53	$432.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.38 / $49.43 / $71.84	Professional	26	$35.38	$49.43	$71.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $189.30 / $301.04 / $375.00	Professional	TC	$189.30	$301.04	$375.00
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $309.67 / $309.67 / $465.97	Professional		$309.67	$309.67	$465.97
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $49.45 / $59.33 / $70.81	Professional	26	$49.45	$59.33	$70.81
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $257.58 / $257.58 / $429.30	Professional	TC	$257.58	$257.58	$429.30
United Facility/Professional Professional Modifier Low / Median / High Price $219.95 / $307.26 / $427.28	Professional		$219.95	$307.26	$427.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.05 / $42.38 / $73.95	Professional	26	$30.05	$42.38	$73.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $238.61 / $367.31	Professional	TC	$187.50	$238.61	$367.31