Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $20.42 / $24.55	Facility	26	$19.95	$20.42	$24.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $72.44 / $190.55	Professional		$47.86	$72.44	$190.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $19.95 / $47.86	Professional	26	$12.02	$19.95	$47.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $50.12 / $87.10	Professional	TC	$36.31	$50.12	$87.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $64.57 / $123.03	Professional		$50.12	$64.57	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $20.89 / $27.54	Professional	26	$11.48	$20.89	$27.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $58.88 / $93.33	Professional	TC	$39.81	$58.88	$93.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $69.18 / $87.10	Professional		$60.26	$69.18	$87.10
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $18.20 / $23.44	Professional	26	$15.85	$18.20	$23.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $50.12 / $64.57	Professional	TC	$43.65	$50.12	$64.57
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.79 / $58.88 / $112.20	Professional		$14.79	$58.88	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $81.28 / $131.83	Professional		$58.88	$81.28	$131.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $21.88 / $32.36	Professional	26	$14.45	$21.88	$32.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $60.26 / $102.33	Professional	TC	$43.65	$60.26	$102.33
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $120.23 / $141.25	Professional		$100.00	$120.23	$141.25
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $27.54 / $32.36	Professional	26	$23.99	$27.54	$32.36
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $77.62 / $107.15	Professional	TC	$57.54	$77.62	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $69.18 / $120.23	Professional		$57.54	$69.18	$120.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $17.78 / $30.20	Professional	26	$14.45	$17.78	$30.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $52.48 / $91.20	Professional	TC	$42.66	$52.48	$91.20