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 / $129.24	Facility	26	$99.54	$123.09	$129.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.99 / $475.00 / $669.75	Professional		$250.99	$475.00	$669.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.06 / $123.10 / $327.58	Professional	26	$64.06	$123.10	$327.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $245.33 / $441.00	Professional	TC	$187.50	$245.33	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $166.96 / $292.38 / $322.81	Professional		$166.96	$292.38	$322.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.73 / $115.45 / $128.78	Professional	26	$57.73	$115.45	$128.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $185.87 / $186.40 / $297.51	Professional	TC	$185.87	$186.40	$297.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $212.43 / $281.16 / $312.39	Professional		$212.43	$281.16	$312.39
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 $136.03 / $180.04 / $200.04	Professional	TC	$136.03	$180.04	$200.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $68.55 / $121.38 / $219.68	Professional		$68.55	$121.38	$219.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $205.20 / $417.16 / $867.86	Professional		$205.20	$417.16	$867.86
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 $129.05 / $263.87 / $690.48	Professional	TC	$129.05	$263.87	$690.48
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $322.83 / $336.24 / $371.23	Professional		$322.83	$336.24	$371.23
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $66.31 / $132.77 / $148.10	Professional	26	$66.31	$132.77	$148.10
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $213.75 / $213.75 / $342.14	Professional	TC	$213.75	$213.75	$342.14
United Facility/Professional Professional Modifier Low / Median / High Price $209.48 / $368.15 / $656.74	Professional		$209.48	$368.15	$656.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.06 / $91.76 / $143.22	Professional	26	$70.06	$91.76	$143.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.59 / $220.66 / $499.10	Professional	TC	$125.59	$220.66	$499.10