Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.57 / $132.05 / $150.93	Facility	26	$119.57	$132.05	$150.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $301.00 / $438.87 / $625.24	Professional		$301.00	$438.87	$625.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.33 / $116.27 / $210.61	Professional	26	$76.33	$116.27	$210.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $212.31 / $309.93 / $508.96	Professional	TC	$212.31	$309.93	$508.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $237.06 / $237.06 / $404.62	Professional		$237.06	$237.06	$404.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $70.77 / $138.75 / $158.04	Professional	26	$70.77	$138.75	$158.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $289.14 / $319.42 / $412.06	Professional	TC	$289.14	$319.42	$412.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $307.70 / $407.25 / $452.50	Professional		$307.70	$407.25	$452.50
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $99.55 / $131.75 / $146.38	Professional	26	$99.55	$131.75	$146.38
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.15 / $275.50 / $306.11	Professional	TC	$208.15	$275.50	$306.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $84.13 / $196.43 / $323.68	Professional		$84.13	$196.43	$323.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $288.05 / $487.19 / $747.12	Professional		$288.05	$487.19	$747.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.81 / $124.21 / $185.19	Professional	26	$87.81	$124.21	$185.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.67 / $374.85 / $606.11	Professional	TC	$199.67	$374.85	$606.11
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $272.62 / $465.31 / $479.35	Professional		$272.62	$465.31	$479.35
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $154.72 / $164.39 / $181.75	Professional	26	$154.72	$164.39	$181.75
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $316.61 / $367.33 / $367.33	Professional	TC	$316.61	$367.33	$367.33
United Facility/Professional Professional Modifier Low / Median / High Price $272.36 / $465.54 / $590.50	Professional		$272.36	$465.54	$590.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.43 / $111.26 / $170.01	Professional	26	$85.43	$111.26	$170.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.81 / $341.87 / $490.21	Professional	TC	$186.81	$341.87	$490.21