Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.86 / $177.79 / $369.30	Facility		$138.86	$177.79	$369.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $30.63 / $51.15	Facility	26	$24.55	$30.63	$51.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $111.99 / $149.34 / $279.13	Professional		$111.99	$149.34	$279.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.44 / $28.07 / $51.45	Professional	26	$18.44	$28.07	$51.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.84 / $123.79 / $202.41	Professional	TC	$87.84	$123.79	$202.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.46 / $161.62 / $238.60	Professional		$95.46	$161.62	$238.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.73 / $31.30 / $39.03	Professional	26	$16.73	$31.30	$39.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $223.33 / $223.33 / $223.33	Professional	TC	$223.33	$223.33	$223.33
BCBS Facility/Professional Facility Modifier Low / Median / High Price $101.45 / $101.45 / $101.45	Facility		$101.45	$101.45	$101.45
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.94 / $201.11 / $201.11	Professional		$151.94	$201.11	$201.11
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.32 / $34.84 / $34.84	Professional	26	$26.32	$34.84	$34.84
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.63 / $166.28 / $166.28	Professional	TC	$125.63	$166.28	$166.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $22.75 / $126.95 / $165.55	Facility		$22.75	$126.95	$165.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.89 / $116.83 / $172.91	Professional		$21.89	$116.83	$172.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $116.48 / $131.27 / $241.68	Facility		$116.48	$131.27	$241.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $139.51 / $209.92 / $266.27	Professional		$139.51	$209.92	$266.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.96 / $32.04 / $43.80	Professional	26	$21.96	$32.04	$43.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $115.39 / $177.09 / $234.34	Professional	TC	$115.39	$177.09	$234.34
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $185.86 / $185.86 / $274.39	Professional		$185.86	$185.86	$274.39
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $36.21 / $44.88	Professional	26	$31.76	$36.21	$44.88
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $256.83 / $256.83 / $256.83	Professional	TC	$256.83	$256.83	$256.83
United Facility/Professional Professional Modifier Low / Median / High Price $129.03 / $185.28 / $260.80	Professional		$129.03	$185.28	$260.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $26.95 / $45.70	Professional	26	$19.89	$26.95	$45.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.80 / $157.30 / $229.80	Professional	TC	$109.80	$157.30	$229.80