Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $212.77 / $321.60 / $953.28	Facility		$212.77	$321.60	$953.28
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.27 / $43.60 / $50.97	Facility	26	$42.27	$43.60	$50.97
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $183.65 / $199.08 / $843.27	Facility	TC	$183.65	$199.08	$843.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.68 / $226.29 / $363.35	Professional		$183.68	$226.29	$363.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.16 / $43.60 / $87.37	Professional	26	$29.16	$43.60	$87.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.62 / $183.65 / $274.32	Professional	TC	$136.62	$183.65	$274.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.19 / $249.79 / $306.77	Professional		$136.19	$249.79	$306.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.22 / $44.86 / $65.97	Professional	26	$25.22	$44.86	$65.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $171.18 / $171.18 / $252.34	Professional	TC	$171.18	$171.18	$252.34
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 $197.30 / $261.14 / $261.14	Professional		$197.30	$261.14	$261.14
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.46 / $49.58 / $49.58	Professional	26	$37.46	$49.58	$49.58
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $159.84 / $211.55 / $211.55	Professional	TC	$159.84	$211.55	$211.55
CareSource Facility/Professional Facility Modifier Low / Median / High Price $32.65 / $163.04 / $215.66	Facility		$32.65	$163.04	$215.66
CareSource Facility/Professional Professional Modifier Low / Median / High Price $31.37 / $149.13 / $225.25	Professional		$31.37	$149.13	$225.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.44 / $205.64 / $434.20	Facility		$154.44	$205.64	$434.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $184.21 / $280.24 / $346.80	Professional		$184.21	$280.24	$346.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.94 / $49.61 / $63.72	Professional	26	$31.94	$49.61	$63.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.08 / $225.91 / $284.54	Professional	TC	$147.08	$225.91	$284.54
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $242.37 / $287.26 / $403.96	Professional		$242.37	$287.26	$403.96
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $34.75 / $51.59 / $62.58	Professional	26	$34.75	$51.59	$62.58
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $196.86 / $196.86 / $290.19	Professional	TC	$196.86	$196.86	$290.19
United Facility/Professional Professional Modifier Low / Median / High Price $169.54 / $239.53 / $339.69	Professional		$169.54	$239.53	$339.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.89 / $42.95 / $70.73	Professional	26	$30.89	$42.95	$70.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.19 / $196.61 / $298.58	Professional	TC	$140.19	$196.61	$298.58