Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.92 / $105.50 / $121.64	Facility	26	$79.92	$105.50	$121.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $202.40 / $475.00 / $1,017.29	Professional		$202.40	$475.00	$1,017.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $117.16 / $357.79	Professional	26	$62.50	$117.16	$357.79
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,536.35 / $1,536.35 / $1,536.35	Professional	50	$1,536.35	$1,536.35	$1,536.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $183.96 / $275.00	Professional	52	$125.00	$183.96	$275.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $225.25 / $335.00 / $502.50	Professional	TC	$225.25	$335.00	$502.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $306.75 / $319.16 / $348.52	Professional		$306.75	$319.16	$348.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.94 / $105.44 / $117.75	Professional	26	$58.94	$105.44	$117.75
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $209.31 / $213.71 / $252.00	Professional	TC	$209.31	$213.71	$252.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.06 / $295.23 / $328.03	Professional		$223.06	$295.23	$328.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.92 / $92.55 / $102.83	Professional	26	$69.92	$92.55	$102.83
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $153.13 / $202.68 / $225.20	Professional	TC	$153.13	$202.68	$225.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $62.68 / $139.66 / $233.43	Professional		$62.68	$139.66	$233.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $211.63 / $438.74 / $758.79	Professional		$211.63	$438.74	$758.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.74 / $97.41 / $141.16	Professional	26	$61.74	$97.41	$141.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $145.29 / $297.95 / $616.40	Professional	TC	$145.29	$297.95	$616.40
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $340.40 / $367.03 / $400.80	Professional		$340.40	$367.03	$400.80
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $114.84 / $122.03 / $135.41	Professional	26	$114.84	$122.03	$135.41
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $240.71 / $245.77 / $289.80	Professional	TC	$240.71	$245.77	$289.80
United Facility/Professional Professional Modifier Low / Median / High Price $205.54 / $366.12 / $581.70	Professional		$205.54	$366.12	$581.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.47 / $78.79 / $127.04	Professional	26	$62.47	$78.79	$127.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $146.82 / $244.79 / $505.32	Professional	TC	$146.82	$244.79	$505.32