Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.38 / $197.70 / $665.60	Facility		$97.38	$197.70	$665.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.73 / $28.42 / $38.36	Facility	26	$22.73	$28.42	$38.36
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $114.78 / $132.00 / $390.00	Facility	TC	$114.78	$132.00	$390.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.23 / $140.69 / $249.90	Professional		$95.23	$140.69	$249.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $28.42 / $94.02	Professional	26	$19.50	$28.42	$94.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.35 / $114.78 / $186.00	Professional	TC	$90.35	$114.78	$186.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.44 / $159.94 / $224.91	Professional		$92.44	$159.94	$224.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.29 / $29.00 / $42.64	Professional	26	$16.29	$29.00	$42.64
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.36 / $109.36 / $182.27	Professional	TC	$109.36	$109.36	$182.27
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 $122.32 / $161.88 / $161.88	Professional		$122.32	$161.88	$161.88
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.41 / $32.31 / $32.31	Professional	26	$24.41	$32.31	$32.31
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.91 / $129.58 / $129.58	Professional	TC	$97.91	$129.58	$129.58
CareSource Facility/Professional Facility Modifier Low / Median / High Price $21.12 / $104.16 / $138.06	Facility		$21.12	$104.16	$138.06
CareSource Facility/Professional Professional Modifier Low / Median / High Price $20.28 / $95.29 / $144.19	Professional		$20.28	$95.29	$144.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $98.20 / $123.30 / $196.03	Facility		$98.20	$123.30	$196.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.04 / $176.84 / $223.42	Professional		$116.04	$176.84	$223.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.64 / $31.70 / $40.92	Professional	26	$20.64	$31.70	$40.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.08 / $144.66 / $186.73	Professional	TC	$93.08	$144.66	$186.73
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $155.19 / $180.57 / $258.64	Professional		$155.19	$180.57	$258.64
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $22.03 / $33.35 / $40.47	Professional	26	$22.03	$33.35	$40.47
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $125.76 / $125.76 / $209.61	Professional	TC	$125.76	$125.76	$209.61
United Facility/Professional Professional Modifier Low / Median / High Price $108.45 / $158.06 / $230.98	Professional		$108.45	$158.06	$230.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.75 / $28.33 / $42.02	Professional	26	$19.75	$28.33	$42.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.00 / $128.76 / $182.08	Professional	TC	$87.00	$128.76	$182.08