Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $93.33 / $102.33	Facility	26	$85.11	$93.33	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $288.40 / $457.09	Professional		$199.53	$288.40	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $79.43 / $151.36	Professional	26	$53.70	$79.43	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $213.80 / $338.84	Professional	TC	$147.91	$213.80	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $181.97 / $416.87	Professional		$173.78	$181.97	$416.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $93.33 / $107.15	Professional	26	$45.71	$93.33	$107.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $158.49 / $275.42	Professional	TC	$154.88	$158.49	$275.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $263.03 / $338.84	Professional		$229.09	$263.03	$338.84
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $74.13 / $95.50	Professional	26	$66.07	$74.13	$95.50
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $186.21 / $239.88	Professional	TC	$162.18	$186.21	$239.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $186.21 / $346.74	Professional		$58.88	$186.21	$346.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $371.54 / $537.03	Professional		$204.17	$371.54	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $87.10 / $144.54	Professional	26	$58.88	$87.10	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $288.40 / $398.11	Professional	TC	$144.54	$288.40	$398.11
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $407.38	Professional		$407.38	$407.38	$407.38
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $114.82 / $123.03	Professional	26	$107.15	$114.82	$123.03
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $316.23 / $316.23	Professional	TC	$316.23	$316.23	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $331.13 / $501.19	Professional		$218.78	$331.13	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $70.79 / $117.49	Professional	26	$56.23	$70.79	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $239.88 / $389.05	Professional	TC	$158.49	$239.88	$389.05