Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.10 / $64.50 / $88.10	Facility	26	$62.10	$64.50	$88.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.00 / $253.19 / $514.53	Professional		$165.00	$253.19	$514.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.98 / $62.11 / $138.75	Professional	26	$44.98	$62.11	$138.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $82.50 / $94.59 / $162.50	Professional	52	$82.50	$94.59	$162.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.82 / $177.61 / $291.63	Professional	TC	$109.82	$177.61	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $201.22 / $201.22 / $219.73	Professional		$201.22	$201.22	$219.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.12 / $65.41 / $74.50	Professional	26	$30.12	$65.41	$74.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $121.73 / $134.50 / $134.50	Professional	TC	$121.73	$134.50	$134.50
BCBS Facility/Professional Professional Modifier Low / Median / High Price $133.30 / $176.43 / $196.03	Professional		$133.30	$176.43	$196.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.98 / $58.21 / $64.68	Professional	26	$43.98	$58.21	$64.68
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $89.32 / $118.22 / $131.35	Professional	TC	$89.32	$118.22	$131.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.65 / $87.77 / $147.19	Professional		$39.65	$87.77	$147.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.75 / $264.00 / $375.83	Professional		$144.75	$264.00	$375.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.49 / $66.76 / $97.65	Professional	26	$44.49	$66.76	$97.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.21 / $172.09 / $274.39	Professional	TC	$91.21	$172.09	$274.39
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $231.40 / $248.01 / $252.69	Professional		$231.40	$248.01	$252.69
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $36.01 / $76.50 / $85.68	Professional	26	$36.01	$76.50	$85.68
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $139.99 / $154.68 / $154.68	Professional	TC	$139.99	$154.68	$154.68
United Facility/Professional Professional Modifier Low / Median / High Price $130.15 / $232.21 / $285.39	Professional		$130.15	$232.21	$285.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.51 / $57.27 / $85.82	Professional	26	$40.51	$57.27	$85.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.78 / $154.63 / $231.33	Professional	TC	$85.78	$154.63	$231.33