Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.76 / $109.86 / $120.99	Facility	26	$75.76	$109.86	$120.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $381.38 / $475.00 / $1,111.50	Professional		$381.38	$475.00	$1,111.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.14 / $120.99 / $189.00	Professional	26	$63.14	$120.99	$189.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $232.51 / $275.00	Professional	52	$125.00	$232.51	$275.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $243.95 / $344.02 / $481.20	Professional	TC	$243.95	$344.02	$481.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $343.70 / $343.70 / $472.98	Professional		$343.70	$343.70	$472.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $76.23 / $113.65 / $126.92	Professional	26	$76.23	$113.65	$126.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $243.95 / $243.95 / $243.95	Professional	TC	$243.95	$243.95	$243.95
BCBS Facility/Professional Professional Modifier Low / Median / High Price $258.48 / $342.11 / $380.12	Professional		$258.48	$342.11	$380.12
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.09 / $99.40 / $110.44	Professional	26	$75.09	$99.40	$110.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $183.38 / $242.71 / $269.68	Professional	TC	$183.38	$242.71	$269.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $67.56 / $159.22 / $261.74	Professional		$67.56	$159.22	$261.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.95 / $507.81 / $740.08	Professional		$263.95	$507.81	$740.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.83 / $99.70 / $151.09	Professional	26	$66.83	$99.70	$151.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.27 / $357.67 / $627.33	Professional	TC	$187.27	$357.67	$627.33
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $395.26 / $395.26 / $543.92	Professional		$395.26	$395.26	$543.92
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $123.77 / $130.69 / $145.96	Professional	26	$123.77	$130.69	$145.96
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $280.54 / $280.54 / $280.54	Professional	TC	$280.54	$280.54	$280.54
United Facility/Professional Professional Modifier Low / Median / High Price $250.33 / $449.71 / $690.28	Professional		$250.33	$449.71	$690.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.84 / $85.13 / $136.88	Professional	26	$68.84	$85.13	$136.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.62 / $312.11 / $518.05	Professional	TC	$179.62	$312.11	$518.05