Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $112.20 / $123.03	Facility	26	$89.13	$112.20	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $331.13 / $660.69	Professional		$199.53	$331.13	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $109.65 / $239.88	Professional	26	$64.57	$109.65	$239.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $97.72 / $147.91 / $169.82	Professional	52	$97.72	$147.91	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $208.93 / $426.58	Professional	TC	$128.82	$208.93	$426.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $186.21 / $346.74	Professional		$128.82	$186.21	$346.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $77.62 / $125.89	Professional	26	$52.48	$77.62	$125.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $186.21 / $309.03	Professional	TC	$95.50	$186.21	$309.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $251.19 / $316.23	Professional		$218.78	$251.19	$316.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $87.10 / $112.20	Professional	26	$75.86	$87.10	$112.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $162.18 / $208.93	Professional	TC	$141.25	$162.18	$208.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $154.88 / $288.40	Professional		$67.61	$154.88	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $467.74 / $776.25	Professional		$190.55	$467.74	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $102.33 / $165.96	Professional	26	$67.61	$102.33	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $288.40 / $645.65	Professional	TC	$128.82	$288.40	$645.65
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $363.08 / $398.11	Professional		$331.13	$363.08	$398.11
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $131.83 / $169.82	Professional	26	$89.13	$131.83	$169.82
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $223.87 / $354.81	Professional	TC	$213.80	$223.87	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $338.84 / $741.31	Professional		$199.53	$338.84	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $83.18 / $141.25	Professional	26	$66.07	$83.18	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $218.78 / $616.60	Professional	TC	$131.83	$218.78	$616.60