Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $100.00 / $104.71	Facility	26	$93.33	$100.00	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $275.42 / $467.74	Professional		$173.78	$275.42	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $169.82	Professional	26	$51.29	$70.79	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $190.55 / $346.74	Professional	TC	$123.03	$190.55	$346.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $173.78 / $354.81	Professional		$147.91	$173.78	$354.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $93.33 / $107.15	Professional	26	$43.65	$93.33	$107.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $173.78 / $229.09	Professional	TC	$102.33	$173.78	$229.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $257.04 / $331.13	Professional		$223.87	$257.04	$331.13
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $81.28 / $104.71	Professional	26	$70.79	$81.28	$104.71
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $173.78 / $223.87	Professional	TC	$151.36	$173.78	$223.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $125.89 / $245.47	Professional		$57.54	$125.89	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $416.87 / $645.65	Professional		$199.53	$416.87	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $93.33 / $154.88	Professional	26	$61.66	$93.33	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $302.00 / $501.19	Professional	TC	$144.54	$302.00	$501.19
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $112.20 / $123.03	Professional	26	$56.23	$112.20	$123.03
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $199.53 / $263.03	Professional	TC	$186.21	$199.53	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $354.81 / $602.56	Professional		$204.17	$354.81	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $77.62 / $125.89	Professional	26	$60.26	$77.62	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $229.09 / $446.68	Professional	TC	$144.54	$229.09	$446.68