Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $211.52 / $252.00 / $1,360.00	Facility		$211.52	$252.00	$1,360.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.37 / $66.37 / $88.78	Facility	26	$66.37	$66.37	$88.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $155.44 / $228.07 / $906.00	Professional		$155.44	$228.07	$906.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.19 / $59.62 / $103.37	Professional	26	$43.19	$59.62	$103.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $110.18 / $156.36 / $211.26	Professional	TC	$110.18	$156.36	$211.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.87 / $113.87 / $113.87	Professional		$113.87	$113.87	$113.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.85 / $47.94 / $80.81	Professional	26	$35.85	$47.94	$80.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $101.10 / $101.10 / $101.10	Professional	TC	$101.10	$101.10	$101.10
BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.70 / $228.57 / $228.57	Professional		$172.70	$228.57	$228.57
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.24 / $61.20 / $61.20	Professional	26	$46.24	$61.20	$61.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $126.46 / $167.37 / $167.37	Professional	TC	$126.46	$167.37	$167.37
CareSource Facility/Professional Facility Modifier Low / Median / High Price $48.65 / $121.35 / $185.89	Facility		$48.65	$121.35	$185.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $45.03 / $100.30 / $158.85	Professional		$45.03	$100.30	$158.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $151.38 / $151.38 / $214.93	Facility		$151.38	$151.38	$214.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.79 / $246.27 / $325.83	Professional		$159.79	$246.27	$325.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.83 / $67.26 / $94.73	Professional	26	$47.83	$67.26	$94.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.69 / $174.71 / $231.10	Professional	TC	$109.69	$174.71	$231.10
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $171.38 / $171.38 / $171.38	Professional		$171.38	$171.38	$171.38
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $55.13 / $55.13 / $92.93	Professional	26	$55.13	$55.13	$92.93
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $116.27 / $116.27 / $116.27	Professional	TC	$116.27	$116.27	$116.27
United Facility/Professional Facility Modifier Low / Median / High Price $399.00 / $399.00 / $399.00	Facility		$399.00	$399.00	$399.00
United Facility/Professional Professional Modifier Low / Median / High Price $130.05 / $207.26 / $317.17	Professional		$130.05	$207.26	$317.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.49 / $60.17 / $92.93	Professional	26	$36.49	$60.17	$92.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $101.05 / $145.63 / $227.55	Professional	TC	$101.05	$145.63	$227.55