Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.54 / $123.09 / $156.68	Facility	26	$99.54	$123.09	$156.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $315.12 / $475.00 / $813.77	Professional		$315.12	$475.00	$813.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.09 / $130.19 / $372.40	Professional	26	$67.09	$130.19	$372.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $174.86 / $294.62	Professional	52	$125.00	$174.86	$294.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $233.00 / $441.00	Professional	TC	$187.50	$233.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $150.35 / $291.89 / $322.27	Professional		$150.35	$291.89	$322.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.34 / $115.33 / $128.78	Professional	26	$53.34	$115.33	$128.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $185.36 / $202.42 / $220.00	Professional	TC	$185.36	$202.42	$220.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $212.10 / $280.72 / $311.91	Professional		$212.10	$280.72	$311.91
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.40 / $101.12 / $112.36	Professional	26	$76.40	$101.12	$112.36
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.69 / $179.60 / $199.55	Professional	TC	$135.69	$179.60	$199.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $68.55 / $121.06 / $219.30	Professional		$68.55	$121.06	$219.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.20 / $417.16 / $795.50	Professional		$202.20	$417.16	$795.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.08 / $110.69 / $154.72	Professional	26	$68.08	$110.69	$154.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.74 / $263.87 / $622.04	Professional	TC	$128.74	$263.87	$622.04
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $332.35 / $339.00 / $370.61	Professional		$332.35	$339.00	$370.61
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $62.48 / $132.77 / $148.10	Professional	26	$62.48	$132.77	$148.10
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $213.16 / $232.78 / $253.00	Professional	TC	$213.16	$232.78	$253.00
United Facility/Professional Professional Modifier Low / Median / High Price $205.07 / $363.47 / $602.27	Professional		$205.07	$363.47	$602.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.56 / $86.36 / $142.88	Professional	26	$70.56	$86.36	$142.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $129.91 / $220.66 / $483.44	Professional	TC	$129.91	$220.66	$483.44