Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.20 / $123.09 / $156.68	Facility	26	$92.20	$123.09	$156.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $232.97 / $475.00 / $922.02	Professional		$232.97	$475.00	$922.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.75 / $123.10 / $242.40	Professional	26	$63.75	$123.10	$242.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $174.86 / $275.00	Professional	52	$125.00	$174.86	$275.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $492.45	Professional	TC	$187.50	$335.00	$492.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $279.39 / $292.86 / $323.35	Professional		$279.39	$292.86	$323.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.82 / $113.05 / $128.78	Professional	26	$54.82	$113.05	$128.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $184.61 / $186.37 / $225.97	Professional	TC	$184.61	$186.37	$225.97
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 / $121.72 / $220.04	Professional		$68.55	$121.72	$220.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $207.82 / $417.82 / $857.40	Professional		$207.82	$417.82	$857.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.23 / $106.39 / $154.72	Professional	26	$68.23	$106.39	$154.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.05 / $264.52 / $690.48	Professional	TC	$129.05	$264.52	$690.48
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $333.45 / $336.79 / $371.85	Professional		$333.45	$336.79	$371.85
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $125.56 / $133.40 / $148.10	Professional	26	$125.56	$133.40	$148.10
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $212.30 / $214.33 / $259.87	Professional	TC	$212.30	$214.33	$259.87
United Facility/Professional Professional Modifier Low / Median / High Price $205.97 / $349.41 / $648.76	Professional		$205.97	$349.41	$648.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.78 / $91.38 / $140.50	Professional	26	$67.78	$91.38	$140.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.40 / $230.48 / $479.28	Professional	TC	$130.40	$230.48	$479.28